Imaging Patterns of Neonatal Subpial Hemorrhage - Provisional Statements on Neurological Outcomes.

Santiago Martinez-Correa, Patricia P Rafful, Karen I Ramirez-Suarez, Angela N Viaene, Lauren A Beslow, Sonika Agarwal, Matthew T Whitehead, Arastoo Vossough, Sara Reis Teixeira
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Abstract

Background and purpose: Subpial hemorrhage is an underrecognized type of hemorrhagic stroke primarily affecting neonates. Blood accumulation in the impermeable pia mater compresses the adjacent cortex, leading to injury. The consequences of this stroke type remain poorly understood. The study aims to evaluate the association between imaging findings and neurological outcomes at follow-up in neonates with subpial hemorrhage.

Materials and methods: We retrospectively included neonates with suspected subpial hemorrhage who underwent brain MRI between January 2012 and February 2024. Two pediatric neuroradiologists evaluated MRIs for subpial hemorrhage location, size, and pattern using a previously described system that classified subpial hemorrhage only (Pattern A), subpial hemorrhage with cortical injury (Pattern B), and subpial hemorrhage with cortical injury and intraparenchymal hemorrhage (Pattern C). They also assessed for medullary vein engorgement/thrombosis. We extracted demographic data, perinatal events, hospital outcomes, and Alberta Infant Motor Scale (AIMS) scores, when available. Descriptive analysis was used for demographic, clinical, and imaging findings. Fisher's exact test evaluated associations between clinical outcomes and imaging findings.

Results: Twenty-nine patients (median gestational age 38 weeks, IQR: 37-39) were included, with 82% having birthweights >2500g. Subpial hemorrhages were most commonly on the right side (66%) and in the temporal lobe (62%). Most hemorrhages measured 1-4 cm (59%). Pattern C (15/29, 52%) was associated with delayed motor development as assessed by AIMS (9/15, 60%) (p=.042), while Pattern B (10/29, 35%) was associated with near-normal motor development (6/15, 40%) (p=.044). There was no statistically significant association between concurrent superficial and deep medullary vein engorgement/thrombosis and the presence of any neurological deficit (p=.055).

Conclusions: The association between subpial hemorrhage patterns and neurological outcomes, particularly motor development, may have important prognostic and management implications. In our cohort, a pattern C of subpial hemorrhage was significantly associated with delayed motor development. Concurrent involvement of superficial and deep medullary vessels may indicate a higher risk of poor neurological outcomes. These findings highlight the importance of early intervention and monitoring in neonates presenting with subpial hemorrhage.

Abbreviations: AIMS= Alberta Infant Motor Scale; IQR= Interquartile Ranges; NICU= Neonatal Intensive Care Unit; SD= Standard Deviations.

新生儿脑膜下出血的影像学模式-神经学预后的临时声明。
背景和目的:脑膜下出血是一种未被充分认识的出血性卒中类型,主要影响新生儿。不可渗透的硬脑膜中的血液积聚压迫邻近的皮质,导致损伤。这种中风类型的后果仍然知之甚少。该研究旨在评估脑膜下出血新生儿随访时影像学表现与神经预后之间的关系。材料和方法:我们回顾性纳入2012年1月至2024年2月期间接受脑MRI检查的疑似脑膜下出血的新生儿。两名儿科神经放射科医生使用先前描述的系统对mri进行评估,以确定脑膜下出血的位置、大小和类型,该系统分为仅脑膜下出血(a型)、脑膜下出血合并皮质损伤(B型)和脑膜下出血合并皮质损伤和肺内出血(C型)。他们还评估了髓静脉充血/血栓形成。我们提取了人口统计数据、围产期事件、医院结果和阿尔伯塔省婴儿运动量表(AIMS)评分,如果有的话。描述性分析用于人口统计学、临床和影像学结果。Fisher的精确测试评估了临床结果和影像学结果之间的关系。结果:纳入29例患者(中位胎龄38周,IQR: 37-39), 82%的患者出生体重为bbb2500g。脑膜下出血最常见于右侧(66%)和颞叶(62%)。大多数出血量为1-4厘米(59%)。根据AIMS评估,模式C(15/ 29,52%)与运动发育延迟相关(9/ 15,60%)(p= 0.042),而模式B(10/ 29,35%)与接近正常的运动发育相关(6/ 15,40%)(p= 0.044)。并发浅、深髓静脉扩张/血栓形成与任何神经功能障碍之间无统计学意义的关联(p= 0.055)。结论:脑膜下出血类型与神经预后,特别是运动发育之间的关联可能具有重要的预后和治疗意义。在我们的队列中,C型脑膜下出血与运动发育迟缓显著相关。同时累及浅髓血管和深髓血管可能表明神经预后不良的风险较高。这些发现强调了早期干预和监测新生儿脑膜下出血的重要性。AIMS= Alberta婴儿运动量表;四分位间距;新生儿重症监护病房;SD=标准差。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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