Table of Contents
Washington University Experience | VASCULAR | Hypoxia-Ischemia, fetal-neonatal | Pontosubicular necrosis | 3A0 Case 3 History
Case 3 History ---- The patient was a three day old male infant, born at 37 weeks estimated gestational age to a 23 year old G2P2 mother after an uncomplicated pregnancy. Shortly after delivery, he was markedly hypoxic with severe respiratory acidosis. Imaging at an OSH showed a large right diaphragmatic hernia with bowel in the right chest and leftward mediastinal shift. He was subsequently intubated and transferred to SLCH on 2/1. He soon failed conventional ventilatory support and was placed on extracorporal membrane oxygenation (ECMO) requiring multiple cannula repositioning, the last requiring a median sternotomy. On DOL #4, he was shown to have a 2-3 cm left intracerebral hemorrhage, at which time care was redirected. He died on 2/4. External exam was notable for bilateral club feet. The patient's mother and physicians requested a postmortem examination to assess for further congenital abnormalities, to evaluate the extent of the intracerebral hemorrhage and to examine for damage to the brainstem, as he was noted to have agonal breathing on admission. ---- At autopsy an immature brain weighing 320 grams showed extensive subarachnoid hemorrhage involving the left hemisphere, severe subacute global hypoxic/ischemic damage with white matter gliosis and choroid plexus hemorrhage
