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. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Salinas Puente Estefany, Blanqueto Fuentes David, Rodríguez Garza Claudia, Dávila Escamilla Ivan, Montemayor Martínez Alberto

Keywords: Fetal, Trauma, Head

Encephalitis is a rare neurological disease which a viral infection or an autoinmune disorder can cause. Regardless of the etiology, the presentation is widely varied with symptoms stemming from headaches to hallucinations to cardiac dysrhythmias. A diagnosis is most commonly reached through an elimination process, due to the vague nature of the symptoms. The purpose of this case is to showcase a patient in which the classical imaging findings of an autoimmune encephailits were absent, in favor of an atypical presentation. A 19-year-old female began with an episode of auditory hallucinations accompanied by a headache, all resolved without treatment. A week later she developed irrational fear as well as nausea and seizures. Visual hallucinations followed, with an altered state of consciousness, memory loss, and a fever of over 100°F. She was admitted into emergency care, where a head CT scan was performed, which revealed a generalized and diffuse decrease in density of the white matter, corresponding to cerebral edema. Spinal fluid revealed a high protein count, with normal glucose and white blood cell count. An electroencephalogram resulted in the presence of theta brain waves with the absence of an epileptogenic area, which indicates a disfunctional neurological state. The patient developed respiratory distress requiring intubation and was admitted into the intensive care unit with a new treatment of antiviral medicine, with the new diagnostic suspicion of encephalitis. A contrast-enhanced thoracoabdominal CT was performed, which revealed a right adnexal theratoma, guiding the diagnostic suspicion to an anti-NMDA induced encephalitis, for which a brain contrast-enhanced MRI was performed, with no classical findings present such as hippocampal atrophy and temporal lobe hyperintensity; instead the T2-based sequences showed cystic oval lesions in the frontal, temporal and occipital lobe, as well as diffuse hyperintensity of white matter, susceptibility weighted sequences showed focal round hypointesities corresponding to microhemorrhages distributed through the entirety of the white matter, and the gadolinium-enhanced sequence showed avid enhancement of the cystic lesions. A second spinal fluid test revealed antibodies against NMDA receptors and immunoglobulin treatment was administered with a poor response from the patient who presented heart failure shortly after and died. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Reyna De La Garza Karla, Salinas Puente Estefany, Mercado Flores Mariana, Rodríguez Garza Claudia, Maya Garcia Haziel, Montemayor Martinez Alberto

Keywords: encephalitis, autoimmune, neuroradiology