Neonatal Cerebellar Hemorrhage

  • Etiology:
    — There is a 5-fold increase in cerebellar volume from 24-40 weeks
    — Hemorrhage into external granular layer which is a cerebellar germinal zone leading to focal or diffuse injury
    — Selective Purkinje and EGCL vulnerability less than 32 weeks
    — Increased incidence with neonatal stress
  • Imaging US:
    — Acute: Echogenic lesion in cerebellum
    — Chronic: Pontocerebellar hypoplasia and atrophy, volume loss of cerebellar hemispheres greater than vermis, may have periventricular leukomalacia or clastic lesions
    — May escape detection on US and result in unexplained cerebellar atrophy,
  • DDX: Pontocerebellar hypoplasia
  • Complications:
    — Can cause brain stem abnormalities or increased head circumference due to ventricular dilation
    — Outcome relatively poor in preterm infants with large hemorrhages
    — Delayed cognition or motor or language and or behavioral development that is more pronounced with large bleeds and vermis involvement
  • Treatment:
  • Clinical:
    — In 10-25% of very preterm infants on postmortem studies
    — In 3% infants born less than 30 weeks gestation
    — May be clinically silent in preterm infants

Radiology Cases of Neonatal Cerebellar Hemorrhage

Radiology Cases of Neonatal Cerebellar Hemorrhage Due to Prematurity

US of cerebellar hemorrhage
Coronal US of the brain (above) shows round areas of increased echogenicity in the cerebellar hemispheres, left larger than right which are also seen on the sagittal US of the left cerebellum (lower left) and right cerebellum (lower right). The ventricular system was dilated due to bilateral intraventricular hemorrhage (not pictured).

Radiology Cases of Neonatal Cerebellar Hemorrhage Due to Extracorporeal Membrane Oxygenation

CT of cerebellar hemorrhage on extracorporeal membrane oxygenation (ECMO)
Axial and coronal CT without contrast of the brain shows three round mixed density lesions in the cerebellum compressing the fourth ventricle and causing hydrocephalus. The fluid-fluid levels in the lesions were felt to represent active bleeding.