SPONTANEOUS INTRACRANIAL HEMORRHAGE OF STRUCTURAL ORIGIN DURING THE FIRST YEAR OF LIFE

Symptomatic intracranial hemorrhage (ICH) in term infants is not commo n, but when it occurs it is usually secondary to trauma, coagulation d isorders and/or hypoxia. The possibility of a structural cause for an infantile ICH is unfortunately not seriously considered until very lat e. In this paper we report the cases of five full-term infants, each o f whom developed ICH secondary to a structural lesion during the Ist y ear of life. Three presented during the newborn period. A congenital s accular aneurysm of the middle cerebral artery in an 8-month old male infant; a posterior fossa arteriovenous malformation in a 2-week old f emale neonate; a deep parietal cavernous angioma in a 6.5-month-old ma le infant; a temporoparietal low-grade astrocytoma in a 12-day old mal e neonate and a temporoparietal desmoplastic ganglioglioma in a 9-day- old male neonate were the structural lesions that were causative for h emorrhage. In all cases but one, the diagnosis was reached by computer ized tomography and/or magnetic resonance imaging. All infants underwe nt surgery for the removal of the hematoma and of the lesion causative for the bleed. All are alive at 19, 3, 11.5, 10, and 5 years, respect ively. We discuss the diagnosis of ICH with special emphasis on contem porary imaging modalities and stress the benefits of aggressive and ti mely surgical treatment. We then consider a concise analysis of the wo rld literature on the occurrence of structural causes of ICH during in fancy.