To explore the prenatal ultrasound imaging features and clinical prognosis of fetal solitary cerebellar hemorrhage (CBH).

The prenatal ultrasonographic manifestations of seven fetuses diagnosed with CHB detected by ultrasonography at Shenzhen Maternity and Child Healthcare Hospital Affiliated to Southern Medical University from January 2012 to August 2021 were reviewed and compared with the MRI image features. The prenatal diagnosis and clinical prognosis of CHB were then analyzed based on the relevant literature.

Abnormal echoes were found in the cerebellum of seven fetuses by prenatal ultrasound, of which five (71.4%) showed hyperecho in the cerebellum, two (28.6%) showed uneven mixed hypoecho and anecho, and all had bilateral cerebellar hemisphere asymmetry. Color Doppler showed no signal of blood flow in tissues with abnormal echo. Antenatal MRI examination of two cases showed right CHB and right cerebellar hypoplasia. The early ultrasonic manifestations of fetal CHB were hyperecho in the cerebellum and silent shadow behind. After 1-2 weeks, the hematoma was gradually absorbed and partially liquefied, and hyperecho was reduced to cystic anecho or uneven hypoecho and anecho. After 1 month, the hematoma was absorbed and the hyperecho or mixed echo disappeared, with asymmetrical bilateral cerebellar hemispheres and hypoplastic cerebellar hemispheres. In terms of pregnancy outcome and follow-up, there were three (42.9%) cases of induced labor, two cases of fetal death (28.6%) in utero, and two cases of normal neurodevelopment in seven months of follow-up postpartum.

Ultrasound combined with MRI can improve the prenatal diagnostic accuracy for CHB. The long-term neurological follow-up results of children with a prenatal diagnosis of CBH can provide data support in parental counseling and improve the pregnancy outcome of fetuses with prenatal CHB.