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Washington University Experience | VASCULAR | Hemorrhage - Neonatal | 24A0 Case 24 History
Case 24 History ---- The patient was born at an estimated gestational age of 24 weeks at 450 g, the product of an initially triplet then twin gestation, born to a 28 year old G6P2SAB5 mother. The patient was delivered blue and limp without heart rate or spontaneous respirations. Apgar scores were 1 at 1 minute and 7 at 5 minutes. The female baby died on her 19th day of life in the ICU at SLCH following an episode on 9/4 of seizure activity and bradycardia. The patient's hospital course was complicated by: hyaline membrane disease status-post Survanta x2 and an oscillating ventilator, candida parapsilosis fungemia status-post seven day treatment with Amphotericin–B, hyperglycemia in the first few days of life, treated with insulin, hypoglycemia treated with hydrocortisone thought to be secondary to brain hemorrhage. ---- Neurologically, the patient had grade IV AVH with IVH first noted on head sonogram 8/19 which subsequently worsened showing extensive bilateral germinal matrix and intraventricular hemorrhage associated with lateral ventriculomegaly. The final ultrasound done on 9/3 showed bilateral intraventricular hemorrhages with associated hydrocephalus involving both the lateral ventricles and the third ventricle. There was also a focal intraparenchymal hemorrhage in the left frontal and parietal lobes adjacent to the lateral horn of the left ventricle. Clinically, the patient began to have seizures on 8/30. She died on 9/4. ---- At autopsy the weight of the unfixed brain was 100 g (normal for 26-27 week gestation is 130 ± 17 g). The leptomeninges show focal subarachnoid hemorrhage involving the midbrain and cerebellar hemispheres. Coronal sections of the cerebral hemispheres reveal dusky discoloration of the cortex and white matter. Subependymal hemorrhages were noted along the lateral ventricles bilaterally. The ventricular system was expanded by intraventricular hemorrhage and clotted blood throughout the lateral ventricles as well as involving the third and fourth ventricles. The ventricular lining is disrupted and irregular. The aqueduct and fourth ventricle are expanded and filled with blood.
