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Washington University Experience | VASCULAR | Hypoxia-Ischemia, neonate, Multicystic Encephalopathy (MCE) | 3A0 Case 3 History
Case 3 History ---- The patient was a 9 year old boy with a history of severe cerebral palsy. He was born at 38 weeks of gestation with macrocephaly diagnosed by ultrasound three days prior to birth. He was delivered by cesarean section because of breech presentation with the Apgar scores of 3 at 1 minute and 9 at 5 minutes. A seizure was first noted seven hours after birth which was controlled with Phenobarbital. However, the patient suffered a severe hypoxic/ischemic event. EEG was severely abnormal with low amplitude waves. A CT scan revealed hydrocephalus of the lateral and third ventricles, subarachnoid blood, and subdural hemorrhage dissecting along the tentorium. The patient was followed by head ultrasounds and CTs that revealed the hydrocephalus to be progressive, which was treated conservatively with Diamox. An MRI at three months of age revealed marked cystic changes of the brain and severe atrophy and hydrocephalus. A VP shunt was placed and revised in 1989. The patient was seen again in 1996 by his doctor and was in his usual state of health until the day of death when he was found grey and "gasping" by his mother. CPR was initiated by the parents and EMS called; however, he expired.
