INTRODUCTION Cerebellar hemorrhage (CH) has been observed in 5 to 10% of the autopsies done on newborn babies. Since neuroimaging techniques have become available it is easier to diagnose the condition. In this paper we report on a series of cases of CH in full­term newborn babies. OBJECTIVES. To determine the number of patients with CH diagnosed by neuroimaging, make a descriptive study and analyze their progress. Results. Between 1984 and 1999 six patients had CH, three boys and three girls, five born after their mother’s first pregnancy. Four were vaginal births; in two forceps were used and in one a vacuum extractor; two were born by cesarean section. Four showed symptoms within the first 48 hours of life, one on the fourth day and one on the twenty fifth day. The latter had hemorrhagic disease of the newborn. In five patients transfontanellar ultrasound was useful in diagnosis. In all six cases computerized axial tomography scan confirmed the diagnosis. Cerebral magnetic resonance (MR) was done in three cases. No arteriovenous malformations were shown on angio-MR. Two patients had hydrocephalus and both were treated by ventriculo­peritoneal shunts. Three cases had transient ventricular dilatation which improved with medical treatment. The patient with hemorrhagic disease of the newborn had alterations in blood clotting. In three patients metabolic studies were normal. Five patients were treated conservatively and only one neurosurgically. Subsequent evolution was characterized by the presence of psychomotor retardation with mild cerebellar signs. At school age, only observed in two cases, there were learning difficulties with a low intellectual coefficient and problems with reading and writing. In one case there was epilepsy, controlled by use of two antiepileptic drugs.

CONCLUSIONS Half the cases of CH seen in full­term newborn babies occurred after dystocic delivery. One case was secondary to hemorrhagic disease of the newborn. The transfontanellar ultrasound is useful in diagnosis. Most patients were managed conservatively. During the clinical course there were psychomotor retardation, cerebellar signs, cognitive deficits with learning problems and epilepsy.

Introducción Las hemorragias cerebelosas (HC) se han observado en el 5-10% de las autopsias neonatales. Con el advenimiento de las técnicas de neuroimagen pueden diagnosticarse con mayor facilidad. En el presente trabajo presentamos nuestra casuística de HC en recién nacidos a término (RNAT).

Objetivos Determinar el número de pacientes con HC diagnosticados por neuroimagen, realizar un estudio descriptivo y analizar su evolución.

Resultados Seis pacientes entre 1984 y 1999 padecieron una HC en el período neonatal, tres niños y tres niñas, cinco producto del primer embarazo; cuatro nacieron vía vaginal –en dos se utilizaron fórceps y en uno vacuum extractor–, y dos fueron cesáreas. Cuatro presentaron sintomatología durante las primeras 48 horas de vida, uno al cuarto día y uno a los 25 días; éste presentó enfermedad hemorrágica del recién nacido (EHRN). En cinco la ecografía tranfontanelar (ECOTF) fue útil en el diagnóstico. En seis la TAC confirmó el diagnóstico y en tres se realizó resonancia magnética (RM) cerebral, la angio­RM no detectó malformaciones arteriovenosas. Dos presentaron hidrocefalia, en ambos se colocó derivación ventriculoperitoneal, y tres presentaron dilatación ventricular transitoria que mejoró con el tratamiento médico. El paciente con EHRN mostró alteraciones de coagulación, en tres los estudios metabólicos fueron negativos. Cinco recibieron tratamiento conservador y solamente uno neuroquirúrgico. La evolución se caracteriza por la presencia de retraso psicomotor con signos cerebelosos leves. En la edad escolar, evaluable sólo en dos casos, se constata la presencia de trastornos de aprendizaje con cociente intelectual bajo y problemas de lectoescritura, un caso manifiesta epilepsia controlada con dos fármacos.

Conclusiones El 50% de las HC que se presentaron en neonatos a término fueron producto de partos distócicos. Un caso fue secuendaria a EHRN. La ECOTF es útil en el diagnóstico. La mayoría fueron tratados con medidas conservadoras. La evolución posterior viene marcada por retraso psicomotor, signos cerebelosos, déficit cognitivos con problemas escolares y epilepsia.