背景:颅内出生相关的硬膜下出血常发生在无症状新生儿中,没有不良的长期后遗症。将出生相关的硬膜下出血与颅内出血的其他病理原因区分开来在医学和医学上都很重要。关于出生相关硬膜下出血发生率的文献有限,它的成像特征,随着时间的推移和进化,主要是因为无症状的婴儿不常规进行头颅MRI检查。
目的:建立出生相关硬膜下出血的发生率和分布,并评估其与各种分娩方式的关系。识别相关特征,并评估MRI上出生相关出血信号变化的顺序演变。
方法:本回顾性研究共纳入200例健康足月新生儿和小婴儿。所有婴儿在出生后0-2个月时接受了脑和颈椎的MRI,并获得了3DT1加权(T1W),3D或2DT2加权(T2W),和轴向弥散加权成像(DWI)序列。扫描评估硬膜下出血的存在和分布,其他颅内出血,和相关的伤害。分析各种分娩方式下颅内出血的发生率。T1W上出血的信号强度之间的关系,T2W,和DWI扫描并分析了婴儿的年龄。应用适当的测试来测试数据的统计显著性。
结果:在200名新生儿中,66(33%)在MRI上可检测到颅内出血,年龄范围为11-25天,包括31名(47%)男性和35名(53%)女性。他们都有硬膜下出血,其中54例(81.8%)位于后颅窝。在少数人中出现了额外的实质性出血,但没有蛛网膜下腔出血,颈椎管出血,皮质桥静脉损伤,或颈椎韧带损伤在研究的限制范围内被确定。在25天以上的受试者中未发现可检测到的颅内出血。按分娩方式划分的硬膜下出血的总发生率在剖宫产分娩的婴儿中为8/68(11.8%),在阴道分娩的婴儿中为58/132(43.9%)。在阴道分娩中,辅助阴道分娩的发生率最高(19/30,63.3%).出生相关硬膜下出血的受试者分为三个年龄组:<13天,13-21天,>21天所有检测到的出血均为T1W高强度。在<13天的组中,所有出血均为T2W低信号。在13-21天组中,73.1%为T2W低信号,而26.9%为T2W混合。>21天组的所有出血均为T2W低信号。在13-21天组中发现了所有DWI高强度出血。
结论:出生相关的硬膜下出血发生在超过三分之一的正常分娩中,并且具有特征性分布,主要在后窝。相关的颈椎硬膜下出血,颈椎韧带损伤,或皮质桥接静脉损伤,这与创伤性病因有关,未被识别。与出生相关的硬膜下出血遵循MRI上信号变化的特征性模式。虽然不完全可靠,这有助于将它们与通常在出生后发生的创伤性颅内出血区分开来。在我们的队列中,25天后未发现与出生相关的硬膜下出血。
BACKGROUND: Intracranial
birth-related subdural hemorrhage frequently occurs in asymptomatic newborns and has no adverse long-term sequelae. It is medically and medicolegally important to differentiate
birth-related subdural hemorrhage from other pathological causes of intracranial hemorrhage. There is limited literature available on the incidence of
birth-related subdural hemorrhage, its imaging features, and evolution over time, mainly because asymptomatic infants do not routinely undergo cranial MRI.
OBJECTIVE: To establish the incidence and distribution of birth-related subdural hemorrhage and evaluate their association with various modes of delivery, identify associated features, and evaluate the sequential evolution of signal changes of the birth-related hemorrhages on MRI.
METHODS: A total of 200 healthy term neonates and young infants were included in this retrospective review study. All infants underwent MRI of the brain and cervical spine at postnatal age of 0-2 months with acquisition of a 3D T1-weighted (T1W), 3D or 2D T2-weighted (T2W), and axial diffusion-weighted imaging (DWI) sequences. The scans were evaluated for the presence and distribution of subdural hemorrhages, other intracranial hemorrhages, and associated injuries. Prevalence of intracranial hemorrhage in various modes of delivery was analyzed. Relationship between the signal intensities of the bleeds on T1W, T2W, and DWI scans and the age of the infants was analyzed. Appropriate tests were applied to test for statistical significance of the data.
RESULTS: Out of 200 neonates, 66 (33%) had detectable intracranial hemorrhage on MRI with an age range of 11-25 days, including 31 (47%) males and 35 (53%) females. All of them had subdural hemorrhages, 54 (81.8%) of which were in the posterior fossa. Additional parenchymal hemorrhages were present in a few, but no subarachnoid hemorrhages, cervical spinal canal hemorrhages, cortical bridging vein injury, or cervical spinal ligamentous injury were identified within the limitations of the study. No detectable intracranial hemorrhage was found in subjects above 25 days of age. Overall incidence of subdural hemorrhage by mode of delivery was 8/68 (11.8%) in babies born by cesarean section and 58/132 (43.9%) in babies born by vaginal delivery. Among the vaginal deliveries, the highest incidence was observed in assisted vaginal delivery (19/30, 63.3%). Subjects with birth-related subdural hemorrhage were categorized into three age groups: <13 days, 13-21 days, and >21 days. All detected hemorrhages were T1W hyperintense. In the <13 days group, all bleeds were T2W hypointense. In the 13-21 days group, 73.1% were T2W hypointense, while 26.9% were T2W mixed. All bleeds in the >21 days group were T2W hypointense. All DWI hyperintense bleeds were found in the 13-21 days group.
CONCLUSIONS: Birth-related subdural hemorrhage occurs in over a third of normal deliveries and has a characteristic distribution, predominantly in the posterior fossa. Associated cervical spinal subdural hemorrhages, cervical spinal ligamentous injury, or cortical bridging vein injury, which are concerning for traumatic etiology, were not identified.
Birth-related subdural hemorrhages follow a characteristic pattern of signal changes on MRI. Although not completely reliable, this can help in differentiating them from traumatic intracranial hemorrhages which usually occur postnatally. No
birth-related subdural hemorrhages were seen after 25 days of age in our cohort.