Table of Contents
Washington University Experience | VASCULAR | Hemorrhage - Neonatal | 18A0 Case 18 History
Case 18 History ---- The decedent was a 9-day-old female infant born at 24 6/7-week EGA to a G2P2 mother with a history of preterm labor. In her short life, the decedent suffered from complications of prematurity: respiratory distress syndrome, intraventricular hemorrhage (grade IV on left, grade III on right), bilateral cerebellar hemorrhages, recurrent seizures status post treatment, concerns for culture-negative sepsis requiring pressors, severe hyperglycemia on insulin, apnea of prematurity on caffeine, pulmonary hypertension, hyperbilirubinemia status post phototherapy, hypernatremia and hyperkalemia, and patent ductus arteriosus s/p acetaminophen treatment. In her last day of life, she developed bradycardia and refractory hypotension. Due to her poor prognosis, she was compassionately extubated and she expired. ---- At autopsy the weight of the unfixed brain was 140 gm (normal, 135 + 24g). A large left cerebral intraventricular hemorrhage with parenchymal extension also involved brainstem and bilateral cerebellum. The subcortical and periventricular white mater showed foamy histiocytes and reactive gliosis. Sections of right basal ganglia and thalamus was remarkable for periventricular subacute infarction composed of neuronal necrosis, karyorrhexis, infiltration of numerous macrophages, gliosis and reactive astrocytosis. CD68 and GFAP IHC of the basal ganglia confirmed the routine H&E impression. There was multifocal germinal matrix hemorrhage with extension into the ventricle with induction of granular ependymitis with scattered fibrin deposits, hemosiderin laden macrophages and undermined or denuded ependymal layer. There were mineralized dentate neurons in the cerebellum.
