Sonographic Detection of In Utero Isolated Cerebellar Hemorrhage

Abstract

Cerebellar hemorrhage is a relatively rare phenomenon in neonates, and most cases are associated with intraventricular hemorrhage (IVH). Prenatally diagnosed intracranial hemorrhage is rare, and diagnoses of cerebellar hemorrhage are even rarer. In our literature search, we discovered 3 cases of prenatal diagnosis of cerebellar hemorrhage, all accompanied by IVH. None of the neonates survived. We report a case initially observed in utero by sonography of cerebellar hemorrhage without evidence of IVH, causing ventriculomegaly in a 32-week twin fetus who was subsequently successfully treated.

Cerebellar hemorrhage in very low birth weight premature infants: The advantage of the posterolateral fontanelle view

“…1,[26][27][28][29] Several case reports have also described in utero diagnosis of cerebellar hemorrhage by both US and MRI. [30][31][32][33][34] Yousefzadeh and Naidish, in 1985, in a study of US anatomy of the posterior fossa with brain section correlation, advocated scanning through the temporal squama in infants up to 20 months for axial images of the brain, including the cerebellum. 16 Since then, the importance of additional views including the mastoid, or posterolateral, fontanelle to demonstrate the cerebellum, vermis, fourth ventricle, and posterior fossa subarachnoid space has been repeatedly emphasized.…”

Outcome of severe unilateral cerebellar hypoplasia

“…Cerebellar haemorrhage has been shown to occur pre-and perinatally. Increasing experience with prenatal ultrasound 3,23 and greater availability of fetal MRI 5,7,24 have demonstrated the prenatal occurrence of cerebellar haemorrhage. In these reports, cerebellar haemorrhages were detected at between 18 and 24 weeks' gestation.…”

Cerebellar hemorrhage in utero associated with ‘massive’ fetal thrombotic vasculopathy

“…Cerebellar hemorrhage in fetuses is an infrequent phenomenon. The condition is rarely diagnosed prenatally, but magnetic resonance imaging is claimed as an optimal tool for identification [11,12]. Ghi et al [10] reviewed cases of antenatally-diagnosed intracranial hemorrhage in their ultrasound unit.…”

“…At our King Chulalongkorn Memorial Hospital, no cerebellar hemorrhage in utero proven by autopsy has been reported in the past 10 years. The prognosis of cerebellar hemorrhage depends on the etiology and extension of the bleeding [11]. The complications in fetuses who survived after bleeding episodes include acute bleeding compression, partial or complete loss of cerebellar mass, cystic formation, brain stem changes ranging from atrophic to absent due to previous pressure effect from adjacent hematomas, and sometimes Dandy-Walker malformation-like change, which is characterized by an absence of on vermis and fourth ventricular enlargement [9,11,13].…”

“…The prognosis of cerebellar hemorrhage depends on the etiology and extension of the bleeding [11]. The complications in fetuses who survived after bleeding episodes include acute bleeding compression, partial or complete loss of cerebellar mass, cystic formation, brain stem changes ranging from atrophic to absent due to previous pressure effect from adjacent hematomas, and sometimes Dandy-Walker malformation-like change, which is characterized by an absence of on vermis and fourth ventricular enlargement [9,11,13]. Trauma [14], post-transfusions [10,15], cavernous hemangiomas [9], congenital cytomegalovirus infection [16], and transformed ischemic lesions [13,17] have been reported as causes of fetal cerebellar hemorrhage.…”