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Washington University Experience | VASCULAR | Hydrocephalus, Post-Hemorrhagic | 6A0 Case 6 History
Case 6 History ---- The patient was a former 25 week estimated gestational age infant born at 846 gm whose mother was a 22 year old G3P1-2 with one abortion. He was born by emergent 'C' section for placental abruption. The pregnancy was complicated by: 1) history of partial abruption two weeks prior to delivery, 2) tobacco use, 3) Maternal severe cervical dysplasia and history of chlamydia. The infant's APGARS were 1 at 1 minute, 1 at 5 minutes, and 2 at 10 minutes, requiring chest compression, bag mask ventilation, intubation, epinephrine x3, and sodium bicarbonate. He received Survanta and was placed on high frequency mechanical ventilation. He was transferred to SLCH at 34 days of life for evaluation of chest mass versus tracheal mass, a workup which led to the diagnosis of staphylococcal tracheitis. He required inotropic support for congestive heart failure while septic with staphylococcal septicemia. He was eventually weaned off of inotropic support but then developed a new murmur which led to the diagnosis of a mitral valve vegetation on echocardiogram. Pressor support was resumed, but his condition deteriorated and he died from congestive heart failure, mitral insufficiency secondary to staphylococcal endocarditis. ---- From a neurologic perspective, the patient was on narcotic and benzodiazepine for much of his post-natal life and therefore, neurologic exam was typically limited to statements regarding arousability. He was noted to have "seizure-like" activity at the outside hospital and was placed on phenobarbital during the first several days of life. An outside hospital head ultrasound revealed intraventricular hemorrhage with ventricular dilatation. His head circumference at one month was 35.5 cm which is the only measurement documented. Head ultrasound performed four days after transfer revealed severe hydrocephalus with dilated lateral and fourth ventricles, evolving intraventricular hemorrhage bilaterally, and periventricular leukomalacia or evolving intraparenchymal hemorrhages in the periventricular regions bilaterally. Follow-up head ultrasound one week later showed an increase in the moderate ventriculomegaly and bilateral IVH with associated right periventricular porencephaly without change. A head ultrasound one week later, showed mild worsening of the ventriculomegaly. An ophthalmology consult found immature retina bilaterally, but no evidence of Roth spots. They found optic nerve hypoplasia versus atrophy versus retinal dystrophy bilaterally. They considered a possible diagnosis of Leber's congenital amaurosis. Other diagnoses included the following: bronchopulmonary dysplasia, candidal urinary tract infection, thrombocytopenia, and bilateral inguinal hernia. The clinical cause of death as documented was congestive heart failure as a consequence of staphylococcal endocarditis, which was likely seeded from staphylococcal tracheitis.
