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Washington University Experience | VASCULAR | Hypoxia-Ischemia, fetal-neonatal | Porencephaly | 3A0 Case 3 History
Case 3 History ---- The patient was a five year old with steroid dependent broncopulmonary dysplasia with reactive airways, swallowing dysfunction and a sleep study with periods of apnea. She was a former 26 week prematurely born infant who developed an intraventricular germinal matrix hemorrhage and spent six months in the neonatal intensive care unit, requiring mechanical ventilation. Epilepsy developed which was treated with Phenobarbital. She was discharged with a static encephalopathy thought to be secondary to perinatal hypoxia-ischemia. She had marked developmental delay and made sounds but not words. She was wheelchair bound, was fed through a G-tube and required a tracheostomy. Her cranial nerves functioned normally. She had fisting of both hands, both feet were held in extension and her reflexes were brisk with upgoing toes. Terminally, the patient was admitted to SLCH for respiratory distress and possible pneumonia, treated, discharged and later found at home in an unresponsive state. She was intubated in the field but became asystolic and resuscitation was performed. Upon arrival at SLCH, she had fixed and dilated pupils, no pulse and no respirations. ---- At autopsy she had periventricular encephaloclastic cysts and diffuse white matter attenuation consistent with perinatal hypoxic-ischemic injury and remote periventricular hemorrhage. Both the encephaloclastic cysts and the diffuse white matter loss detected in this patient's brain are compatible with a history of "static encephalopathy" secondary to perinatal hypoxic-ischemic insult.
