1/16. Unexpected birth trauma with near fatal consequences.Rupturing of the liver due to delivery is an uncommon but severe birth trauma. Although described in the preterm neonate with very low birthweight or after complicated delivery, we present a case of capsular liver haemorrhage in a term newborn with normal birthweight after a seemingly uncomplicated delivery. The infant presented with severe shock and petechiae as first symptoms and initial therapy was based on the hypothesis of sepsis. Clinical suspicion of liver haemorrhage a few hours later was confirmed with abdominal ultrasound. Since shock was not amenable to fluid replacement therapy, the haemorrhage had to be managed surgically. Even without evidence of birth trauma, intra-abdominal bleeding must always be suspected in a newborn with suddenly prevailing shock and unexpected anaemia.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/16. vacuum assisted delivery--the need for caution.In the United Kingdom and Republic of ireland 10% of all deliveries are vacuum assisted. The vacuum is preferred over forceps because it is easier to perform and associated with less maternal morbidity. It is, however, also associated with subaponeurotic haemorrhage that has an incidence of 6.4 per 1000 vacuum assisted deliveries and a mortality of 23%. Based on a figure of 77,500 births annually in ireland, North and South, it is possible that as many as 11 neonatal deaths each year may attributable to what is generally considered a safe obstetric intervention. In north america concerns about the safety of vacuum assisted delivery resulted in the issuing of public health advisories in both canada and the united states. To date such concerns have not been raised in either the United Kingdom or Republic of ireland. We report a case of fatal subaponeurotic haemorrhage to highlight and bring these concerns to the attention of obstetricians, paediatricians and midwives. We also call for the introduction of a national surveillance in order to assess the true extent of this potentially fatal complication.- - - - - - - - - - ranking = 0.66666666666667keywords = haemorrhage (Clic here for more details about this article) |
3/16. Leptomeningeal cyst: early diagnosis by color Doppler imaging.A newborn with a leptomeningeal cyst over the anterior fontanelle due to birth trauma is described. color Doppler flow sonograms were helpful to diagnose the leptomeningocele in its early stages and to differentiate it from a cephalhematoma or subgaleal haemorrhage by demonstrating cerebro-fugal flow in an arterial connection between the extracranial fluid collection and the dural space.- - - - - - - - - - ranking = 0.33333333333333keywords = haemorrhage (Clic here for more details about this article) |
4/16. Traumatic neonatal intracranial bleeding and stroke.Ischaemia within the regions supplied by vertebral and posterior cerebral arteries has been described as a complication of birth injury, either by direct trauma or by compression from a herniated temporal uncus. Ischaemia within the territory of the middle cerebral artery has been documented after a stretch injury of the vessel's elastica interna. From a series of seven personal observations on birth trauma and related cerebral stroke, we describe three neonates with the uncal herniation type of occipital stroke and four infants with hypoperfusion of the middle cerebral artery or one of its major branches. In three of the latter a basal convexity subdural haemorrhage probably induced the ischaemia, whereas in the other it was associated with haemorrhagic contusion of the parietal lobe. Experimental work and reports on older children support the idea that vasospasm due to surrounding extravasated blood can be one of the responsible mechanisms. Both forceps delivery and difficult vacuum extraction can be implicated in this supratentorial injury, leading to permanent neurological damage in at least half of the survivors in this series.- - - - - - - - - - ranking = 3.5971666977267keywords = subdural, haemorrhage (Clic here for more details about this article) |
5/16. An extradural and subdural hematoma in a neonate.Traumatic brain injury following birth is common in newborn but significant intracranial haematoma following birth injury is not that usual. Even busy pediatric trauma center have about only 1 to 3 % of admission that require neurosurgical care. Extradural haematoma (EDH) associated with intracerebral and subdural haematoma (SDH) is even more rare in newborn. If this is not detected and treated in time, the outcome may be fatal. A case of EDH with subdural and intracerebral haematoma in a 3 days old neonate is presented. Etiology and problems in diagnosis and management are discussed.- - - - - - - - - - ranking = 23.364461880911keywords = subdural, haematoma, subdural haematoma (Clic here for more details about this article) |
6/16. Progressive syringomyelia controlled by treatment of associated hydrocephalus in an infant with birth injury. Case report.The author's aim in reporting this case is to extend awareness of the importance of management of associated hydrocephalus among patients with syringomyelia to the posttraumatic state. A full-term infant was delivered by cesarean section because of transverse lie. In the 2nd week of life, hypotonia affecting the lower limbs and the left upper limb was recognized. On MR imaging, posterior fossa subdural hemorrhage and spinal cord injury at the T-1 and T-2 levels were evident. Sequential imaging studies demonstrated progressive myelomalacic changes in the cervical spinal cord and eventual development of syrinx cavities as far cephalad as C-3. hydrocephalus developed simultaneously as well. A ventriculoperitoneal cerebrospinal fluid shunt was inserted at 22 months of age. Six months after shunt insertion, MR imaging demonstrated regression of the posttraumatic syringomyelia. The patient was stable from an imaging standpoint at 16 months after shunt insertion, and she has continued to make developmental progress. The importance of treatment of associated hydrocephalus is widely recognized in the management of syringomyelia associated with the Chiari malformations. It should be considered in the management of posttraumatic syringomyelia as well.- - - - - - - - - - ranking = 3.2638333643934keywords = subdural (Clic here for more details about this article) |
7/16. On the management of neonatal tentorial damage. Eight case reports and a review of the literature.From the history of 15 personal patients--8 reported here in extenso--and from 63 patients in the literature with the diagnosis of posterior fossa subdural haemorrhage during life, we discuss the possibility of detecting tentorial damage on computed tomography (CT) and ultrasound (US) scan. The association of a (peri)cerebellar haemorrhage with peritentorial bleeding around the straight sinus and a subdural haemorrhage between both occipital cerebral lobes is suggestive of tentorial laceration(s). Both coronal CT scan and sagittal US scan are very helpful in locating these haemorrhages near the falco-tentorial junction. The conservative management of one of our infants with very extensive but asymmetric posterior fossa haemorrhage, leading to resorptive hydrocephalus, is compared with both surgical and conservative treatment of patients from the literature. Two reasons that warrant neurosurgical intervention are: life-threatening brain-stem compression--as in one of our own patients--and acute obstructive hydrocephalus. craniotomy of the posterior fossa within the neonatal period does not prevent later-onset resorptive hydrocephalus. The communicating nature of this latter process is adequately demonstrated by lumbar isotope cisternography. Finally, neonatal posterior fossa subdural haemorrhage is one of the many causes of cyst-like structures behind the cerebellum.- - - - - - - - - - ranking = 11.79150009318keywords = subdural, haemorrhage (Clic here for more details about this article) |
8/16. Tentorial hemorrhage associated with vacuum extraction.The clinical and radiologic descriptions of three neonates with tentorial hemorrhage after vacuum extraction are reported. All patients were full term, with Apgar scores of 8 or more; one patient experienced fetal distress during delivery. Within 36 hours after birth, the neonates had multiple generalized seizures; computed tomography or magnetic resonance imaging outlined distinctive tentorial hemorrhages with extension over the superior surface of the cerebellum or inferior surface of the occipital lobe. One patient had diffuse hypoxic-ischemic injury, and another had bilateral temporal lobe infarcts. Treatment included medical control of seizures and intracranial hypertension; one patient had surgical evacuation of bilateral subdural hematomas. Follow-up from 1 to 5 years showed significant developmental delays in two patients. These cases demonstrate that the forces generated on the fetal cranium by vacuum extraction are similar to those produced by forceps and result in tentorial laceration, venous rupture, and subdural hemorrhage. Because these hemorrhages may be associated with significant ischemic injury, serial radiologic evaluation is recommended for the detection of persistent structural abnormalities.- - - - - - - - - - ranking = 6.5276667287867keywords = subdural (Clic here for more details about this article) |
9/16. Epidural hematoma of the newborn due to birth trauma.Epidural hematoma due to birth trauma is unusual. The presentation is similar to subdural hematoma in the newborn, but the results of subdural puncture may be normal. The CT scan is diagnostic and early surgical evacuation may be lifesaving.- - - - - - - - - - ranking = 6.5276667287867keywords = subdural (Clic here for more details about this article) |
10/16. anterior chamber haemorrhage in the newborn after spontaneous delivery. A case report.A case report is presented of anterior chamber haemorrhage occurring in one eye in a newborn after spontaneous delivery. At the age of two weeks the anterior chamber was clear but the vitreous cloudy. At the age of five weeks the vitreous had also cleared. The infant's later development was normal and there were no disorders in the function of the eye.- - - - - - - - - - ranking = 1.6666666666667keywords = haemorrhage (Clic here for more details about this article) |
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