Prenatal cerebellar hemorrhage: fetal and postnatal neuroimaging findings and postnatal outcome.
BACKGROUND
Despite significant progress in fetal neuroimaging techniques, only a few well-documented examples of prenatal cerebellar hemorrhages are available in the literature. In the majority of these individuals, the diagnosis of prenatal cerebellar hemorrhages led to termination of pregnancy or death occurred in utero; data about postnatal outcome of children with prenatal diagnosis of cerebellar hemorrhages are scant. We describe fetal and postnatal neuroimaging findings and the neurodevelopmental outcome of a child with a large cerebellar hemorrhage that occurred at approximately 27 weeks' gestation.


METHODS
Data about neurological features and neurodevelopmental outcome were collected from the clinical history and follow-up examination. All pre- and postnatal MRI data were qualitatively evaluated for infra- and supratentorial abnormalities.


RESULTS
Fetal MRI at 27 weeks' gestation showed a T1-hyperintense and T2-hypointense lesion within the cerebellum suggestive of bilateral cerebellar hemorrhages with extension into the adjacent subarachnoid, subdural, and intraventricular spaces. The prenatal cerebellar hemorrhage was possibly related to maternal sepsis. Postnatal MRI showed encephalomalacic changes involving the vermis and both cerebellar hemispheres. Neurodevelopmental follow-up at 15 months of age was concerning for global developmental delay and significant right esotropia.


CONCLUSIONS
This child illustrates (1) the role of prenatal neuroimaging in the diagnosis of fetal cerebellar hemorrhages, (2) the significance of cerebellar involvement for neurodevelopment, and (3) the importance of the collection of postnatal outcome data in children with prenatal diagnosis of cerebellar hemorrhage.
Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Madoka
M
Hayashi
Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Andrea
A
Poretti
Sinai Hospital, Baltimore, Maryland.
Michelle
M
Gorra
Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; International Center for Maternal and Newborn Health, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland.
Azadeh
A
Farzin
Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ernest M
EM
Graham
Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Thierry A G M
TA
Huisman
Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: frances@jhmi.edu.
Frances J
FJ
Northington
D002526:Cerebellar Diseases / Q000150:complications* / Q000175:diagnosis; D002658:Developmental Disabilities / Q000209:etiology*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000000981:diagnostic imaging*; D059906:Neuroimaging; D011247:Pregnancy; D011296:Prenatal Diagnosis; D014463:Ultrasonography
cerebellum; fetal; hemorrhage; magnetic resonance imaging; outcome