Researchers described the clinical characteristics, or signs, of a rare subtype of intracranial hemorrhage (ICH) in a study recently published in Neuroradiology. ICH is one of the most dangerous potential complications of fetal and newborn alloimmune thrombocytopenia (FNAIT).
ICHs are classified according to their location. Subdural hemorrhages are located between the outermost layer of connective tissue covering the brain dura mater) and the middle layer (arachnoid mater) and represents the most common ICH in newborns. Subpial hemorrhages, on the other hand, occur between the inner layer (pia mater) and the brain itself. Unlike subdural hemorrhages, subpial hemorrhages are rare.
“This study is the largest to systematically identify the HPm-sign on TOF-MRA, which may assist neuroradiologists in distinguishing subpial hemorrhage from other types of neonatal hemorrhages in some cases, “ the authors wrote.
In order to gain a deeper understanding of the clinical characteristics associated with subpial hemorrhage, the authors analyzed the medical record of 28 newborns with subpial hemorrhage.
Clinical manifestations of subpial hemorrhage
The most common clinical manifestations were apneic events (periods where the patient stopped breathing) and seizures. Underlying medical conditions included low platelet count (thrombocytopenia), infection, traumatism and hypoxic encephalopathy.
Learn more about FNAIT signs and symptoms
Approximately 97% of patients had another ICH associated with subpial hemorrhage. In over 80% of cases, the hemorrhage was classified as big.
The authors identified a characteristic magnetic resonance imaging (MRI) finding presence in 21 out of 28 patients. The ying-yang sign consisted of a dark (hypointense) hemorrhage in contact with a very white (hyperintense) cerebral cortex. The hyperintensity in the cerebral cortex is indicative of brain infarction.
Regarding outcomes, the authors observed a survival rate of over 70%, the eight patients who died during the study succumbed to a combination of factors apart from subpial hemorrhage. Five survivors presented with neurological deficits at follow-up including motor abnormalities and epilepsy.
“Further research is essential to better understand the underlying mechanisms and to assess the long-term neurological outcomes in neonates affected by subpial hemorrhage,” the authors concluded.
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