Purpose or Case Report: Intracranial hemorrhage (ICH) and ischemic brain injury are rare in the fetus. The most common location of hemorrhage in the fetus is intraventricular and is related to prematurity. Intracranial hemorrhage in the fetus can be intra or extra-axial and its recognition is important because of its complications and poor outcome. The causes of fetal intracranial hemorrhage are idiopathic, maternal, and of the fetus; maternal causes vary, and the main is trauma. Domestic violence increases during pregnancy, placing the mother and the fetus at risk for injury.
Features of central nervous system nonaccidental trauma in pediatric patients are well established, however, there are not too many examples in the literature of these imaging findings in the fetal stage.
The purpose of this case is to demonstrate the features of intracranial hemorrhage and ischemic brain injury caused by nonaccidental trauma during pregnancy and the evolution after birth.
The subject of this case report is a 36-week gestation product referred because of severe ventriculomegaly detected during an obstetric ultrasound; a fetal MRI was performed which showed an acute to subacute hemispheric bilateral subdural hematoma, infratentorial subdural hemorrhage, retroclival hematoma, subarachnoid hemorrhage, ventriculomegaly, brain edema, and midline shift. The patient was born at 38 weeks through C-section with no respiratory effort and a 4 points APGAR score, he was intubated and spent 38 days in the NICU, during his stay a postnatal transfontanelar ultrasound and a brain MRI were performed and showed persistence of the supratentorial and infratentorial subdural hematomas bigger in size with an epidural component, retroclival hematoma, subarachnoid hemorrhage, brain edema, midline shift, uncal herniation and hemispheric ischemic vascular event. The etiology of this extensive and atypical presentation hemorrhage was inquired including coagulation and genetic disorders, and the medical background of the parents which came out normal; after thorough interrogation, the mother revealed trauma related to domestic violence.
In our case, we will show that the localization and features of nonaccidental trauma of the central nervous system in the fetal stage are similar to the pediatric stage.
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