term idiopathic subarachnoid hemorrhage implies a primary subarachnoid
hemorrhage without a known cause. Secondary subarachnoid hemorrhage results
from a spill of blood into the arachnoid space from a brain parenchymal
hemorrhage, an intraventricular hemorrhage, or a hemorrhagic infarct.
The term secondary subarachnoid hemorrhage is also used for hemorrhages
in the subarachnoid space if the cause is known. Seizures are the most
common manifestations. They usually occur after the first day of life.
The clinical presentation of secondary subarachnoid hemorrhage is often
dominated by the cause of the subarachnoid hemorrhage. In cases of idiopathic
subarachnoid hemorrhage, the neonate appears healthy. The diagnosis is
established by CT or MRI of the brain. In a neonate with seizures and
subarachnoid hemorrhage, other causes for the seizures should be considered.
The prognosis of a neonate with idiopathic subarachnoid hemorrhage is
good. Subarachnoid hemorrhages require no treatment but careful follow-up
is necessary due to the possibility of hydrocephalus. Seizures should
be treated with antiepileptic drugs. More
and Intraparenchymal Hemorrhages
hemorrhage usually presents as lethargy or irritability. Seizures are
uncommon but other types of pathological paroxysmal motor events often
occur. Intraparenchymal hemorrhages are more frequent than intraventricular
hemorrhages in neonates born at term. Seizures are a frequent presentation
of intraparenchymal hemorrhages in fullterm neonates.
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are the most common presenting sign of cerebral infarction in neonates.
Focal motor deficit often persists after the convulsion stops. Cerebral
arterial infarction may occur because of endomural, mural, or extramural
abnormalities affecting a vessel. Endomural occlusions are either embolic
or thrombotic. The source of the emboli is usually the heart or the placenta.
Embolic strokes are frequentinneonateswith
cyanotic heart disease because the venous blood bypasses the lungs (natural
filter). Thrombosis results from trauma, coagulopathies (proteins C and
S deficiencies), or polycythemia. More