Presentation
Newborn with hypoxic-ischaemic encephalopathy due to abruptio placentae.
Patient Data
Caput succedaneum.
DWI shows global ischaemia in both cerebral hemispheres. Cerebral oedema with resultant narrowed ventricles and sulci and barely discernible supratentorial cisterns. The superior portion of the brainstem and the superior aspect of the vermis are ischaemic as well. The cerebellar hemispheres, pons and medulla appear normal.
Negative lactate peak at 1.4 ppm on MRS (not shown).
No parenchymal haematoma. A small subdural haematoma can be missed on SWI.
Normal signal in all the large intracranial vessels.
Case Discussion
Term newborn delivered by urgent caesarean section due to abruptio placentae. Low Apgar score. Presented with hypoxic-ischaemic encephalopathy manifesting as hypotonia, severe metabolic acidosis, hyponatraemia and transient tachypnoea of newborn (TTN). Underwent 72-hour whole-body cooling. Cerebral function monitoring (CFM) displayed a very low trace. Later, slight brain activity was seen, partly as seizures and partly as burst suppression. Due to convulsions, both clinical and electrical, he received several anticonvulsants which were gradually discontinued. EEG displayed flattening of electrical brain activity without any epileptic activity.
MRI showed severe global cerebral ischaemia with oedema.
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