Intracranial Hemorrhage and Stroke in the Neonate

Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) continues to be a common form of brain injury in very preterm infants. Despite major advances in neonatology, GMH-IVH remains associated with high rates of neurodevelopmental impairment (NDI), especially when complicated by progressive post-hemorrhagic ventricular dilatation (PHVD) and periventricular hemorrhagic infarction. Cranial ultrasonography (cUS) is the most widely used neuroimaging modality since the early 1980s for the diagnosis of GMH-IVH. Serial cUS scanning allows early detection and accurate grading of the hemorrhage and monitoring of its complications, especially PHVD. Data are accumulating to suggest that PHVD should be treated before the onset of clinical symptoms. cUS is less sensitive than magnetic resonance imaging (MRI) in identifying hemorrhages in the temporal and occipital regions, coexisting subtle white matter injury, and small cerebellar hemorrhages (CBHs). Infarction within the territory of a major artery or a branch arising from it around the time of birth is referred to as perinatal stroke. Perinatal arterial ischemic stroke (PAIS) is a form of arterial stroke that usually presents with focal clonic seizures in the first few days after birth. Cerebral sinovenous thrombosis (CSVT) is classified as a venous type of stroke, which may present with IVH with or without unilateral thalamic hemorrhage in a term neonate. The first part of this chapter focuses on GMH-IVH and PHVD in the preterm infant as well as extra-axial hemorrhages in the term infant, whereas the second part focuses on perinatal stroke, mainly PAIS and CSVT.