Clinical Observations Prenatal Cerebellar Hemorrhage: Fetal and Postnatal Neuroimaging Findings and Postnatal Outcome Madoka Hayashi MD a, b , Andrea Poretti MD b, c , Michelle Gorra MD d , Azadeh Farzin MD a, b, e , Ernest M. Graham MD b, f , Thierry A.G.M. Huisman MD b, c , Frances J. Northington MD a, b, * a Division of Neonatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland b Neuro Intensive Care Nursery Group, The Johns Hopkins University School of Medicine, Baltimore, Maryland c Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland d Sinai Hospital, Baltimore, Maryland e International Center for Maternal and Newborn Health, Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland f Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland abstract BACKGROUND: Despite significant progress in fetal neuroimaging techniques, only a few well-documented exam- ples of prenatal cerebellar hemorrhages are available in the literature. In the majority of these cases, the diagnosis of prenatal cerebellar hemorrhages led to termination of pregnancy or death occurred in utero; data about postnatal outcome of children with prenatal diagnosis of cerebellar hemorrhages are scant. We describe fetal and postnatal neuroimaging findings and the neurodevelopmental outcome of a child with a large cerebellar hem- orrhage that occurred at approximately 27 weeks’ gestation. METHOD: Data about neurological features and neurodevelopmental outcome were collected from the clinical history and follow-up examination. All pre- and postnatal MRI data were qualitatively evaluated for infra- and supratentorial abnormalities. RESULTS: Fetal MRI at 27 weeks’ gestation showed a T1-hyperintense and T2-hypointense lesion within the cerebellum suggestive of bilateral cerebellar hemorrhages with extension into the adjacent subarachnoid, subdural, and intraventricular spaces. The prenatal cerebellar hemorrhage was possibly related to maternal sepsis. Postnatal MRI showed encephalomalacic changes involving the vermis and both cerebellar hemispheres. Neurodevelopmental follow-up at 15 months of age was concerning for global developmental delay and significant right esotropia. CONCLUSION: This child illustrates (1) the role of prenatal neuroimaging in the diagnosis of fetal cerebellar hemorrhages, (2) the significance of cerebellar involvement for neurodevelopment, and (3) the importance of the collection of postnatal outcome data in children with prenatal diagnosis of cerebellar hemorrhage. Keywords: cerebellum, hemorrhage, fetal, magnetic resonance imaging, outcome Pediatr Neurol 2015; -: 1-6 Ó 2015 Elsevier Inc. All rights reserved. Introduction Significant cerebellar hemorrhage is an important complication of preterm birth. 1 The prevalence of signifi- cant cerebellar hemorrhage in preterms differs based on the birth weight between 3% (birth weight <1500 g) and 9% (birth weight <750 g). 2 The overall prevalence may be as high as 20% when including small hemorrhages. 1 Significant Article History: Received October 6, 2014; Accepted in final form January 22, 2015 * Communications should be addressed to: Dr. Northington; Professor of Pediatrics; Division of Neonatology; Department of Pediatrics; The Johns Hopkins University School of Medicine; CMSC 6-104; 600 North Wolfe Street; Baltimore, MD 21287. E-mail address: frances@jhmi.edu Contents lists available at ScienceDirect Pediatric Neurology journal homepage: www.elsevier.com/locate/pnu 0887-8994/$ e see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pediatrneurol.2015.01.011 Pediatric Neurology xxx (2015) 1e6