A Case of Neonatal Cytotoxic Lesions of the Corpus Callosum With Subpial Hemorrhage.

Subpial hemorrhage is a rare type of birth-related brain hemorrhage in neonates that can manifest with symptoms such as apnea and seizures. On brain magnetic resonance imaging (MRI), subpial and parenchymal hemorrhages are typically observed but often resolve without lasting sequelae. Cytotoxic lesions of the corpus callosum (CLOCCs) are not as common in neonates as they are in adults and children. We present a rare case of a term neonate with subpial hemorrhage accompanied by CLOCCs who experienced a favorable clinical course. A full-term female infant was delivered via emergency cesarean section. At 18 hours post-birth, the infant experienced recurrent seizures. Following phenobarbital administration and the initiation of respiratory support, a brain MRI performed on day 6 revealed hematomas in the subpial and subcortical regions, leading to a diagnosis of subpial hemorrhage. Additionally, diffusion restriction was noted in the corpus callosum and optic radiation extending to the posterior limb. Follow-up MRI on day 14 of life showed the resolution of most of the lesions, confirming the diagnosis of CLOCCs. The infant was discharged on day 22 without further seizures and has shown normal growth and development for 18 months post-discharge. Thus, this case reports a neonatal patient with typical radiological features and clinical progression of subpial hemorrhage and CLOCCs, leading to a favorable outcome. The positive outcome underscores the importance of understanding the unique radiological features and progression of these conditions. In neonates presenting with splenial lesions associated with brain hemorrhage, it is crucial to monitor the resolution of symptoms and lesions to rule out alternative diagnoses. Furthermore, continued developmental monitoring is recommended to ensure optimal outcomes.