Concluded Case

BIRTH ASPHYXIA IN HIE STAGE II

4days old neonate presented with H/o Not crying immediately after birth,He had multiple seizures and was loaded with injection Gardinal,levepil and Epsolin. Hyponatremia was corrected over 48hrs.Currently patient is off oxygen and doesn't have any episode of seizures.Baby is moving Diagnosis DIAGNOSIS? Management Suggest further management plan

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Concluded answer

Birth trauma or birth asphyxia with intra- cranial haemorrhage involving the left occipital, temporo- parietal region with intra- ventricular extension with significant mid line shift to left An urgent Neurosurgical consultation is needed for any possibility of craniectomy The cause of such ICH in new,borns is due to several factors Immature cerebral venous system has several vulnerabilities because (i) development of cerebral venous system occurs late in relation to that of the arteries, (ii) there is sequential remodeling and considerable individual variation in the pattern and size of different veins entering the internal cerebral veins, (iii) immature veins have high caliber and thin wall, they branch parallel to the ventricle, hence tend to collapse, (iv) because of relative paucity of superficial cortical veins between 24 and 28 weeks of gestation, most of the cerebral venous drainage is dependent on the deep galenic system that drains GM and most of the white matter, and (v) the periventricular veins, particularly the terminal (thalamostriate) vein, which is the main vein draining the white matter passes directly through the GM and takes a U-turn to join the internal cerebral vein.

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Blood in the left sylvian fissure ,intethemispheric fissure, lobsr hematoma left temporo parietal with perlesional edema and uncal herniation to rt.Rt lateral ventricle started dialating. Birth asphyxia with HIE resulting in SAH withICH. Prognosis seems to be poor.

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Birth trauma or birth asphyxia with intra- cranial haemorrhage involving the left occipital, temporo- parietal region with intra- ventricular extension with significant mid line shift to left An urgent Neurosurgical consultation is needed for any possibility of craniectomy The cause of such ICH in new,borns is due to several factors Immature cerebral venous system has several vulnerabilities because (i) development of cerebral venous system occurs late in relation to that of the arteries, (ii) there is sequential remodeling and considerable individual variation in the pattern and size of different veins entering the internal cerebral veins, (iii) immature veins have high caliber and thin wall, they branch parallel to the ventricle, hence tend to collapse, (iv) because of relative paucity of superficial cortical veins between 24 and 28 weeks of gestation, most of the cerebral venous drainage is dependent on the deep galenic system that drains GM and most of the white matter, and (v) the periventricular veins, particularly the terminal (thalamostriate) vein, which is the main vein draining the white matter passes directly through the GM and takes a U-turn to join the internal cerebral vein.

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must be birth trauma..it's a large intracerebral bleed and needs urgent surgery

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Had with ventricular breakthrough with mid line shift

Acute cerebral bleed with ventricular breakthrough midline shift

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