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previously visited 071204 NEONATAL HEMORRHAGIC INFARCTION Random Case
Authored By: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.
Patient: 3 day old female
History: Chief complain: Cyanosis after feeding since secondary day of life. Poor activity.
Normal spontaneous delivery with gestational age 37 weeks.
Birthbody weight: 2650gm. G2P2A0
Apgar score: 9 (at 1st min) to 10 (at 5th min).
Smooth prenatal course.
Images:[small]mediumlargeas-submittedimages only

Fig. 1: Brain Ultrasound_coronal

Fig. 2: Brain Ultrasound_sagittal

Fig. 3: MRI_T1WI

Fig. 4: MRI_T2WI

Fig. 5: MRI_STIR

Fig. 6: MRI_FLAIR

Fig. 7: MRI_DWI

Fig. 8: MRI_ADC

Fig. 9: MRI_MRA

Fig. 10: Brain Ultrasound_coronal

Fig. 11: Brain Ultrasound_Power Doppler_coronal

Fig. 12: Brain Ultrasound_Power Doppler_sagittal
Images:[small]mediumlargeas-submittedimages only
Findings:

Initial Brain Ultrasound (fig.1-2):
1. Hyperechoic change of left corpus striatum (red arrows in fig.1,
   2) and corona radiata (yellow arrow in fig.1) without
   midline shift.

MRI of brain (5 days later) with T1 weighted echo train spin echo,
 T2 weighted echo train spin echo, fluid-attenuated inversion
 recovery echo train spin echo, MR diffusion imaging, short
 inversion time inversion recovery echo train spin echo, time-of-
 flight MR angiogarphy with 3D maximum-intensity projection
 reconstruction, and without intravenous contrast (fig.3-9):

1. Lobulated long T2 change (red arrows in fig.4,5) with significant
   restricted water diffusibility (red arrows in fig.7,8) in left
   corpus striatum, at least including caudate nucleus and both
   anterior (yellow arrows in fig.7,8) and posterior (green arrows in
   fig.7,8) limbs of internal capsule, and extension into medial (blue
   arrows in fig.7,8) and middle (pink arrows in fig.7,8) base of
   left cerebral peduncle in midbrain, suggesting neonatal brain
   infarction with at least left deep cerebral nuclei and
   corticospinal and frontopontine tracts involvement.
2. Focal heterogeneous short T1 and dark T2 (orange arrows in fig3-6)
   change within the lesion at left lentiform nucleus and corona
   radiata, in favor of post infarction hemorrhagic transformation
   with intracellular methemoglobin accumulation.
3. No detectable abnormal finding in intracranial arteries,
   including left middle cerebral artery (red arrow in fig.9).

Follow up brain ultrasound with power Doppler images (fig.10-12):
1. Decreased the high echogenic signal in left corpus striatum
   (red arrows in fig.10) compared to previous ultrasound (fig.1).
2. No detectable abnormal finding in intracranial arteries,
   including left middle cerebral artery (red arrow in fig.11).

Diagnosis: Neonatal hemorrhagic infarction, left brain.
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Additional Details:

Case Number: 12345484Last Updated: 12-19-2007
Rating:

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Anatomy: Cranium and Contents   Pathology: Vascular
Modality: MR, USAccess Level: Readable by all users
Keywords: hemorrhagic infarction, cerebral peduncle, corticospinal tractACR: 138.78
Case has been viewed 1016 times.

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