The clinical presentation of preterm cerebellar haemorrhage

Abstract

The objective of this study was to evaluate clinical symptoms and findings on cranial ultrasound (CUS) in preterm infants with cerebellar haemorrhage through retrospective analysis of all preterm infants with a postnatal CUS or MRI diagnosis of cerebellar haemorrhage admitted in a tertiary care centre between January 2002 and June 2009. Fifteen infants were identified; median gestational age was 25 2/7 weeks and median birth weight 730 g. We discerned six types of haemorrhage: subarachnoid (n = 3), folial (n = 1), lobar (n = 9, of which 4 bilateral), giant lobar (n = 1, including vermis) and contusional (n = 1). Especially in infants with lobar cerebellar haemorrhage, CUS showed preceding or concurrent lateral ventricle dilatation, mostly without intraventricular haemorrhage (IVH). Thirteen infants suffered from notable, otherwise unexplained motor agitation in the days preceding the diagnosis. In conclusion, motor agitation may be a presenting symptom of cerebellar haemorrhage in preterm infants. Unexplained ventriculomegaly can be a first sign of cerebellar haemorrhage and should instigate sonographic exploration of the cerebellum.

Serial cranial ultrasonography or early MRI for detecting preterm brain injury?

“…WMI was classified into cystic PVL and diffuse non-cystic WMI; the latter were defined as periventricular inhomogeneous echodensities on CUS or diffuse WMI on MRI 4 17. Cerebellar haemorrhage was categorised into folial or lobar cerebellar haemorrhage 23. Presence of brain injury on CUS scans was based on cumulative findings of all serial assessments up until discharge from our NICU.…”

Pathogenesis, neuroimaging and management in children with cerebral palsy born preterm

“…In the extremely preterm infant, the cerebellum is a recognized site of hemorrhage or underdevelopment, which is detected using cranial ultra-sound through a posterior fontanelle (although the views may be limited) [Ecury-Goossen et al, 2010]. Findings may be unilateral or bilateral.…”

Brain Injury in Preterm Infants: Pathogenesis and Nursing Implications

“…28 CH presentation may be silent, may present with diffuse signs such as apnea, bradycardia, eye deviations, and altered tone, or less commonly the infant may present with catastrophic deterioration. 18,28,30 A recent study reported unexplained episodes of motor agitation in many infants later diagnosed with CH, hypothesizing that the damage from the hemorrhage reduced the usual motor inhibitory effect of the cerebellum. 30 CH can also lead to damage and altered development in other areas of the brain in addition to the cerebellum.…”

“…18,28,30 A recent study reported unexplained episodes of motor agitation in many infants later diagnosed with CH, hypothesizing that the damage from the hemorrhage reduced the usual motor inhibitory effect of the cerebellum. 30 CH can also lead to damage and altered development in other areas of the brain in addition to the cerebellum. 6,24 Outcomes are related to the site of the hemorrhage, extensiveness of the damage, and presence of supratentorial IVH.…”

“…A recent study identified six types: extrusion of subarachnoid hemorrhage into the cerebellums, small folial hemorrhage, bleeding in the cerebellar germinal matrix, bilateral lobal hemorrhage, extensive lobar hemorrhage involving the vermis and contusional hemorrhage secondary to birth trauma. 30 CH accompanied by supratentorial injury has a high mortality. 23,25,28 Recent recognition of a silent presentation confined to the cerebellum ranging from mild unilateral focal injury to extensive hemorrhage that involves both cerebellar hemispheres as well as the vermis (area between the hemispheres) that may or may not be associated with…”