OTHER INTRACRANIAL HEMORRHAGES

Subarachnoid hemorrhage. Most frequent bleed, between pia matter and arachnoid membrane.   This type of bleed is more frequent in preterm babies and is often asymptomatic. In full term babies, it may present as refractory seizures with onset typically within the second day ("well baby" with seizures).   Catastrophic deterioration and neuropathologic complications are rare unless associated with asphyxia. Best diagnostic tool: CT scan.

Subdural hemorrhage. The least common, between dura matter and subarachnoid space. This type of hemorrhage is associated with traumatic delivery in full term infant and coagulation/platelet disorder. The symptoms depend on severity and location of bleeding.   The prognosis is best for cerebral convexities and worst for posterior fossa bleeds. If signs of brainstem compression suggest infratentorial hematoma, initial neuroimaging should be a CT scna. Al LP should NOT be performed as it may provoke herniation. An MRI may be needed for posterior fossa bleed.

Intracerebellar hemorrhage. Uncommon, more in preterm, found 5-10% of autopsy reports in NICU patients. In term babies, it is associated with traumatic events, difficult breech or forceps. This manifests within 24 hours in term infants, but may be delayed up to 3 weeks in preterm and may progress rapidly. Signs of brainstem compression (apnea, bradycardia, facial paresis, eye deviation) may be present.   The outcome is poor in premies; in term babies, half develop hydrocephalus and/or   long term neurologic deficits.

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