Case 4 History ---- The patient was a 12 day old baby girl who died of an inoperable CNS arteriovenous malformation which had resulted in congestive heart failure. The patient was delivered at 37 weeks of estimated gestational age via an augmented labor and delivery because her mother presented with a two day history of headache and low-grade fevers associated with mild hypertension and tachycardia during which the patient had variable decelerations followed by an uncomplicated vaginal delivery. APGARS were 8 at 1 minute and 8 at 5 minutes. The patient had mild cyanosis noted on delivery with an O2 saturation initially of 75% that improved to 90% with supplemental oxygen. The birth weight was 6 lbs. 7 oz. General examination revealed no dysmorphic features. A murmur was auscultated at the left sternal border as well as over the anterior fontanel, and the infant had mild hepatomegaly. Neurologic examination appeared otherwise appropriate for her age. An echocardiogram revealed pulmonary hypertension, dilated Ra/Rv/Lv, a left to right atrial patent foramen ovale defect, and a markedly enlarged superior vena cava consistent with cardiac failure, thought likely due to a possible intracranial arteriovenous malformation. MRI/MRA/MRV revealed a markedly enlarged cerebral hemispheric collection of veins, arteries, and sinuses. Her CNS malformation was not felt to be surgically correctable. She subsequently was discharged to home with hospice care and died 10 days later.
