Idiopathic Neonatal Subpial Hemorrhage with Underlying Cerebral Infarct: Imaging Features and Clinical Outcome

MR images of 3 term neonates. The subpial hemorrhage consistently shows hyperintense T1 signal, hypointense T2 signal, no restricted diffusion, and hypointense signal on GRE T2*WI. In the first patient (A–D), the underlying cerebral cortex and white matter have no hemorrhage. In the second patient (E–H), a mild fan-shaped hemorrhage is seen in the underlying white matter, resulting in a hypointense signal on T2WI, DWI, and T2*WI, while the cerebral cortex remains hyperintense on T2WI, DWI, and T2*WI. In the third patient (I–L), more severe hemorrhage is seen in the underlying white matter, leading to an obscured cerebral cortex on T2*WI and a partially obscured cortex on DWI.

Yin-yang sign. T2WI and DWI of 3 term neonates with subpial hemorrhage are shown. In the brain parenchyma underlying the subpial bleed, no hemorrhage is seen in the first patient (A and B); mild hemorrhage, in the second patient (C and D); and severe hemorrhage, in the third patient (E and F). Irrespective of the presence or degree of intraparenchymal hemorrhage, the combination of a dark subpial fluid collection and a bright underlying cerebral cortex forms a consistent, distinct image pattern (circled areas in A–F), resembling the yin-yang symbol in Chinese philosophy.