Skip to main content
SpringerLink
Log in

Nontraumatic Intracranial Hemorrhage in Infants and Children

  • Living reference work entry
  • First Online:
Pediatric Neuroradiology

  • 454 Accesses

Abstract

Nontraumatic (or spontaneous) intracranial hemorrhage most commonly involves the brain parenchyma in children. The most frequent causes are vascular etiologies. Other important causes include neoplasms, hematologic disorders, and hemorrhagic infarcts (both venous and arterial). These hemorrhages can lead to significant disability and mortality. We will first review the various imaging techniques used in the evaluation of intracranial hemorrhage and the appearance of various stages of hemorrhage on imaging. We will then review the common and less common causes of intracerebral hemorrhage and their imaging appearance. Finally, causes of spontaneous epidural, subdural, subarachnoid, and intraventricular hemorrhage beyond the neonatal period will be reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  • Al-Jarallah A, Al-Rifai MT, Riela AR, Roach ES. Nontraumatic brain hemorrhage in children: etiology and presentation. J Child Neurol. 2000;15:284–9.

    Article  CAS  PubMed  Google Scholar 

  • Allen JC, Miller DC, Budzilovich GN, Epstein FJ. Brain and spinal cord hemorrhage in long-term survivors of malignant pediatric brain tumors: a possible late effect of therapy. Neurology. 1991;41:148–50.

    Article  CAS  PubMed  Google Scholar 

  • ApSimon HT, Reef H, Phadke RV, Popovic EA. A population-based study of brain arteriovenous malformation: long-term treatment outcomes. Stroke. 2002;33:2794–800.

    Article  CAS  PubMed  Google Scholar 

  • Atluru VL. Spontaneous intracerebral hematomas in juvenile diabetic ketoacidosis. Pediatr Neurol. 1986;2:167–9.

    Article  CAS  PubMed  Google Scholar 

  • Beslow LA, Smith SE, Vossough A, Licht DJ, Kasner SE, Favilla CG, Halperin AR, Gordon DM, Jones CI, Cucchiara AJ, Ichord RN. Hemorrhagic transformation of childhood arterial ischemic stroke. Stroke. 2011;42:941–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Blom I, De Schryver EL, Kappelle LJ, Rinkel GJ, Jennekens-Schinkel A, Peters AC. Prognosis of haemorrhagic stroke in childhood: a long-term follow-up study. Dev Med Child Neurol. 2003;45:233–9.

    Article  PubMed  Google Scholar 

  • Bradley Jr WG. MR appearance of hemorrhage in the brain. Radiology. 1993;189:15–26.

    Article  PubMed  Google Scholar 

  • Byard RW, Bourne AJ, Hanieh A. Sudden and unexpected death due to hemorrhage from occult central nervous system lesions. A pediatric autopsy study. Pediatr Neurosurg 1991–1992; 17:88–94.

    Google Scholar 

  • Dave P, Curless RG, Steinman L. Cerebellar hemorrhage complicating methylmalonic and propionic acidemia. Arch Neurol. 1984;41:1293–6.

    Article  CAS  PubMed  Google Scholar 

  • de Swiet M. The epidemiology of hypertension in children. Br Med Bull. 1986;42:172–5.

    Article  PubMed  Google Scholar 

  • Di Rocco C, Tamburrini G, Rollo M. Cerebral arteriovenous malformations in children. Acta Neurochir. 2000;142:145–56.

    Article  CAS  PubMed  Google Scholar 

  • Dolinskas CA, Bilaniuk LT, Zimmerman RA, Kuhl DE. Computed tomography of intracerebral hematomas. I. Transmission CT observations on hematoma resolution. AJR Am J Roentgenol. 1977a;129:681–8.

    Article  CAS  PubMed  Google Scholar 

  • Dolinskas CA, Bilaniuk LT, Zimmerman RA, Kuhl DE, Alavi A. Computed tomography of intracerebral hematomas. II. Radionuclide and transmission CT studies of the perihematoma region. AJR Am J Roentgenol. 1977b;129:689–92.

    Article  CAS  PubMed  Google Scholar 

  • Elkhunovich M, Sirody J, McCormick T, Goodarzian F, Claudius I. The utility of cranial ultrasound for detection of intracranial hemorrhage in infants. Pediatr Emerg Care 2016. [Epub ahead of print]

    Google Scholar 

  • Epstein MA, Packer RJ, et al. Iatrogenic vascular malformations mimicking tumor relapse following cranial irradiation for chiasmatic/hypothalamic glioma (CHG) (abstr). Neurology. 1990;40:140.

    Google Scholar 

  • Fiorelli M, Bastianello S, von Kummer R, del Zoppo GJ, Larrue V, Lesaffre E, Ringleb AP, Lorenzano S, Manelfe C, Bozzao L. Hemorrhagic transformation within 36 hours of a cerebral infarct: relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort. Stroke. 1999;30:2280–4.

    Article  CAS  PubMed  Google Scholar 

  • Fischer AQ, Challa VR, Burton BK, McLean WT. Cerebellar hemorrhage complicating isovaleric acidemia: a case report. Neurology. 1981;31:746–8.

    Article  CAS  PubMed  Google Scholar 

  • Fogarty PF, Segal JB. The epidemiology of immune thrombocytopenic purpura. Curr Opin Hematol. 2007;14:515–9.

    Article  PubMed  Google Scholar 

  • Fullerton HJ, Achrol AS, Johnston SC, McCulloch CE, Higashida RT, Lawton MT, Sidney S, Young WL, UCSF BAVM Study Project. Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations. Stroke. 2005;36:2099–104.

    Article  PubMed  Google Scholar 

  • Ganesan V, Saunders DE. Hemorrhagic stroke. In: Ganesan V, Kirkham FJ, editors. Stroke and cerebrovascular disease in childhood, vol. 2011. London: MacKeith Press; 2011. p. 160–83.

    Google Scholar 

  • Gomori JM, Grossman RI, Goldberg HI, Zimmerman RA, Bilaniuk LT. Intracranial hematomas: imaging by high-field MR. Radiology. 1985;157:87–93.

    Article  CAS  PubMed  Google Scholar 

  • Gong J, Sun H, Shi XY, Liu WX, Shen Z. Pure subdural haematoma caused by rupture of middle cerebral artery aneurysm: case report and literature review. J Int Med Res. 2014;42:870–8.

    Article  PubMed  Google Scholar 

  • Grossman RI, Gomori JM, Goldberg HI, Hackney DB, Macchi PJ, Hecht-Leavitt C, Zimmerman RA, Bilaniuk LT. Magnetic resonance imaging of hemorrhagic conditions. Acta Radiol Suppl. 1986;369:53–5.

    CAS  PubMed  Google Scholar 

  • Haacke EM, Mittal S, Wu Z, Neelavalli J, Cheng YC. Susceptibility-weighted imaging: technical aspects and clinical applications, part 1. AJNR Am J Neuroradiol. 2009;30:19–30.

    Article  CAS  PubMed  Google Scholar 

  • Hakim AM, Ryder-Cooke A, Melanson D. Sequential computerized tomographic appearance of strokes. Stroke. 1983;14:893–7.

    Article  CAS  PubMed  Google Scholar 

  • Hamilton RL, Haas RH, Nyhan WL, Powell HC, Grafe MR. Neuropathology of propionic acidemia: a report of two patients with basal ganglia lesions. J Child Neurol. 1995;10:25–30.

    Article  CAS  PubMed  Google Scholar 

  • Hermier M, Nighoghossian N, Derex L, Berthezène Y, Blanc-Lasserre K, Trouillas P, Froment JC. MRI of acute post-ischemic cerebral hemorrhage in stroke patients: diagnosis with T2*-weighted gradient-echo sequences. Neuroradiology. 2001;43:809–15.

    Article  CAS  PubMed  Google Scholar 

  • Hornig CR, Dorndorf W, Agnoli AL. Hemorrhagic cerebral infarction – a prospective study. Stroke. 1986;17:179–85.

    Article  CAS  PubMed  Google Scholar 

  • Jordan LC, Kleinman JT, Hillis AE. Intracerebral hemorrhage volume predicts poor neurologic outcome in children. Stroke. 2009;40:1666–71.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kerr CB. Intracranial haemorrhage in haemophilia. J Neurol Neurosurg Psychiatry. 1964;27:166–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kidwell CS, Saver JL, Carneado J, Sayre J, Starkman S, Duckwiler G, Gobin YP, Jahan R, Vespa P, Villablanca JP, Liebeskind DS, Vinuela F. Predictors of hemorrhagic transformation in patients receiving intra-arterial thrombolysis. Stroke. 2002;33:717–24.

    Article  PubMed  Google Scholar 

  • Kidwell CS, Chalela JA, Saver JL, Starkman S, Hill MD, Demchuk AM, Butman JA, Patronas N, Alger JR, Latour LL, Luby ML, Baird AE, Leary MC, Tremwel M, Ovbiagele B, Fredieu A, Suzuki S, Villablanca JP, Davis S, Dunn B, Todd JW, Ezzeddine MA, Haymore J, Lynch JK, Davis L, Warach S. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. 2004;292:1823–30.

    Article  CAS  PubMed  Google Scholar 

  • Kim AC, Vu D, Gonzalez G, Schaefer PW. Conventional MRI and MR angiography of stroke. In: Gonzalez RG, Hirsch JA, Koroshetz WJ, Lev MH, Schaefer PW, editors. Acute ischemic stroke: imaging and intervention. Berlin: Springer; 2006. p. 115–37.

    Google Scholar 

  • Laurent JP, Bruce DA, Schut L. Hemorrhagic brain tumors in pediatric patients. Childs Brain. 1981;8:263–70.

    CAS  PubMed  Google Scholar 

  • Letarte N, Bressler LR, Villano JL. Bevacizumab and central nervous system (CNS) hemorrhage. Cancer Chemother Pharmacol. 2013;71:1561–5.

    Article  CAS  PubMed  Google Scholar 

  • Lo WD. Childhood hemorrhagic stroke: an important but understudied problem. J Child Neurol. 2011;26:1174–85.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lo WD, Lee J, Rusin J, Perkins E, Roach ES. Intracranial hemorrhage in children: an evolving spectrum. Arch Neurol. 2008;65:1629–33.

    Article  PubMed  Google Scholar 

  • Luttrell CN, Finberg L. Hemorrhagic encephalopathy induced by hypernatremia. I. Clinical, laboratory, and pathological observations. AMA Arch Neurol Psychiatry. 1959;81:424–32.

    Article  CAS  PubMed  Google Scholar 

  • Maldjian JA, Listerud J, Moonis G, Siddiqi F. Computing diffusion rates in T2-dark hematomas and areas of low T2 signal. AJNR Am J Neuroradiol. 2001;22:112–8.

    CAS  PubMed  Google Scholar 

  • Nabavizadeh SA, Feygin T, Harding BN, Bilaniuk LT, Zimmerman RA, Vossough A. Imaging findings of patients with metastatic neuroblastoma to the brain. Acad Radiol. 2014;21:329–37.

    Article  PubMed  Google Scholar 

  • New PF, Aronow S. Attenuation measurements of whole blood and blood fractions in computed tomography. Radiology. 1976;121:635–40.

    Article  CAS  PubMed  Google Scholar 

  • Noguchi K, Ogawa T, Seto H, Inugami A, Hadeishi H, Fujita H, Hatazawa J, Shimosegawa E, Okudera T, Uemura K. Subacute and chronic subarachnoid hemorrhage: diagnosis with fluid-attenuated inversion-recovery MR imaging. Radiology. 1997;203:257–62.

    Article  CAS  PubMed  Google Scholar 

  • Page C, Gardner K, Height S, Rees DC, Hampton T, Thein SL. Nontraumatic extradural hematoma in sickle cell anemia: a rare neurological complication not to be missed. Am J Hematol. 2014;89:225–7.

    Article  PubMed  Google Scholar 

  • Pereira VM, Geibprasert S, Krings T, Aurboonyawat T, Ozanne A, Toulgoat F, Pongpech S, Lasjaunias PL. Pathomechanisms of symptomatic developmental venous anomalies. Stroke. 2008;39:3201–15.

    Article  PubMed  Google Scholar 

  • Riikonen R, Donner M. ACTH therapy in infantile spasms: side effects. Arch Dis Child. 1980;55:664–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Roach SE, Lo WD, Heyer GL (2011). Pediatric stroke and cerebrovascular disorders. New York: Demos Medical Publishing, 2012.

    Google Scholar 

  • Shah N, Reichel T, Fleckenstein JL. Diffusion findings in blood clot: the last word? AJNR Am J Neuroradiol. 2004;25:157.

    PubMed  Google Scholar 

  • Stapf C, Mast H, Sciacca RR, Berenstein A, Nelson PK, Gobin YP, Pile-Spellman J, Mohr JP, New York Islands AVM Study Collaborators. The New York Islands AVM study: design, study progress, and initial results. Stroke. 2003a;34:e29–33.

    Article  CAS  PubMed  Google Scholar 

  • Stapf C, Khaw AV, Sciacca RR, Hofmeister C, Schumacher HC, Pile-Spellman J, Mast H, Mohr JP, Hartmann A. Effect of age on clinical and morphological characteristics in patients with brain arteriovenous malformation. Stroke. 2003b;34:2664–9.

    Article  CAS  PubMed  Google Scholar 

  • Strouse JJ, Hulbert ML, DeBaun MR, Jordan LC, Casella JF. Primary hemorrhagic stroke in children with sickle cell disease is associated with recent transfusion and use of corticosteroids. Pediatrics. 2006;118:1916–24.

    Article  PubMed  Google Scholar 

  • Thompson AL, Kosior JC, Gladstone DJ, Hopyan JJ, Symons SP, Romero F, Dzialowski I, Roy J, Demchuk AM, Aviv RI, PREDICTS/Sunnybrook ICH CTA Study Group. Defining the CT angiography ‘spot sign’ in primary intracerebral hemorrhage. Can J Neurol Sci. 2009;36:456–61.

    Article  PubMed  Google Scholar 

  • Tong KA, Ashwal S, Obenaus A, Nickerson JP, Kido D, Haacke EM. Susceptibility-weighted MR imaging: a review of clinical applications in children. AJNR Am J Neuroradiol. 2008;29:9–17.

    Article  CAS  PubMed  Google Scholar 

  • Velasco-Sánchez D, Gómez-Lopez L, Vilaseca MA, Serrano M, Massaguer S, Campistol J, García-Cazorla A. Cerebellar hemorrhage in a patient with propionic acidemia. Cerebellum. 2009;8:352–4.

    Article  PubMed  Google Scholar 

  • Vossough A, Zimmerman RA, Bilaniuk LT, Schwartz EM. Imaging findings of neonatal herpes simplex virus type 2 encephalitis. Neuroradiology. 2008;50:355–66.

    Article  PubMed  Google Scholar 

  • Wada R, Aviv RI, Fox AJ, Sahlas DJ, Gladstone DJ, Tomlinson G, Symons SP. CT angiography “spot sign” predicts hematoma expansion in acute intracerebral hemorrhage. Stroke. 2007;38:1257–62.

    Article  PubMed  Google Scholar 

  • Woody RC, Laney M. A second case of infantile intracranial hemorrhage and severe neurological sequelae following theophylline overdose. Dev Med Child Neurol. 1986;28:121–2.

    Article  CAS  PubMed  Google Scholar 

  • Wu Z, Li S, Lei J, An D, Haacke EM. Evaluation of traumatic subarachnoid hemorrhage using susceptibility-weighted imaging. AJNR Am J Neuroradiol. 2010;31:1302–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Zimmerman RA, Naidich TP. Magnetic resonance angiography. In: Salcman MA, editor. Current techniques in neurosurgery. Philadelphia: Current Medicine; 1993.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA

    Arastoo Vossough & Robert A. Zimmerman

Authors
  1. Arastoo Vossough
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert A. Zimmerman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arastoo Vossough .

Editor information

Editors and Affiliations

  1. Department of Neuroradiology, G Gaslini Children's Hospital, Genoa, Italy

    Andrea Rossi

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer-Verlag GmbH Germany

About this entry

Cite this entry

Vossough, A., Zimmerman, R.A. (2016). Nontraumatic Intracranial Hemorrhage in Infants and Children. In: Rossi, A. (eds) Pediatric Neuroradiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46258-4_14-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-46258-4_14-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-46258-4

  • Online ISBN: 978-3-662-46258-4

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation