ABSTRACT
The authors report a case of minimal prenatal trauma producing a large subdural hematoma in the fetus, which was diagnosed in utero by MR imaging. The occurrence of such a complication is extremely rare in the absence of significant maternal trauma. Prenatally diagnosed intracranial hemorrhages, particularly those that are subdural in origin, have a poor prognosis in most cases. After birth, brain compression required a complex neurosurgical intervention because simple hematoma evacuation was not possible. The clinical and neurological outcome at 6 months was excellent, as confirmed by the neuroimaging findings.
Subject(s)
Abdominal Injuries/complications , Brain Injuries/embryology , Brain Injuries/etiology , Hematoma, Subdural/embryology , Hematoma, Subdural/etiology , Pregnancy , Wounds, Nonpenetrating/complications , Abdominal Injuries/physiopathology , Adult , Craniotomy , Female , Hematoma, Subdural/diagnosis , Hematoma, Subdural/surgery , Humans , Imaging, Three-Dimensional , Infant, Newborn , Intracranial Hemorrhages/diagnosis , Intracranial Hemorrhages/embryology , Intracranial Hemorrhages/etiology , Intracranial Hemorrhages/surgery , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Movement Disorders/etiology , Neurosurgical Procedures , Postoperative Complications , Prenatal Diagnosis , Seizures/etiology , Severity of Illness IndexABSTRACT
OBJECTIVES: Risk factors for intracranial hemorrhage occurring in prenatal life are imperfectly known. A case of prenatal diagnosis of subdural hemorrhage associated with multiple intracranial vascular aneurysms is described. METHODS: Sonography and magnetic resonance imaging of the fetal head were obtained at 21 weeks' gestation and compared with pathologic findings. RESULTS: Sonography showed a large transonic mass displacing the normal intracranial structures. Magnetic resonance imaging demonstrated the hemorrhagic origin of the mass and showed multiple vascular anomalies. Postmortem examination confirmed the compression of the cerebral hemisphere by a blood collection, probably because of bleeding from one of the multiple vascular aneurysms into the subdural space. CONCLUSION: Magnetic resonance imaging with the use of single-shot ultrafast sequences may be useful not only in the differential diagnosis of fetal intracranial hemorrhage but also in identifying vascular risk factors.
