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Abstract

Introduction Traumatic brain injury requiring operative intervention in a neonate as a result of motor vehicle collision (MVC) whilst in utero is extremely rare. There have been only a few reported cases of brain injury in infants following in utero trauma as a result of MVC in the literature. The infants sustain significant injuries such as intraventricular haemorrhage, contusion and sub-arachnoid haemorrhage and do not survive. Case Report Our patient is a child delivered via an emergency caesarean section at 37+4 weeks due to foetal distress following an MVC involving his mother. Low APGHAR at birth (4). Developed seizures and required phenobarbitone. CT and MRI head revealed a large right parietal skull fracture and severe traumatic brain injury (TBI) with intraventricular haemorrhage, subarachnoid blood and a subdural with subgaleal haematoma. The patient improved to feeding, moving all four limbs and crying appropriately but developed a growing skull fracture clinically and radiologically (Figure 1) over a period of weeks. Repair of growing skull fracture was performed with dural layer reconstituted and bony edges apposed. Liquefied infarcted brain tissue was removed. There were no neurosurgical concerns post-operatively. Literature Review Our literature review demonstrated that cases of traumatic brain injury following in utero trauma are extremely rare with only 5 cases identified. We identified one case of lethal foetal head injury and placental abruption, following an MVC. As in this case, an emergency C-section was performed. However, after failed attempts at resuscitation the patient was pronounced dead. Post-mortem analysis indicated a right parietal fracture, with subarachnoid and subgaleal haemorrhage, as in our case1 (Figure 2). Another case series outlined the pathology in four cases of traumatic brain injury in neonates following MVC in utero2. Unfortunately, all of the neonates died despite the mother only experiencing minor trauma in half of the cases. CONCLUSION This case demonstrates the severity of the sequelae following a post-MVC in-utero traumatic brain injury. Despite this presentation being rare, it is associated with high mortality and morbidity. Management may be helped by improved reporting of foetal injury following MVCs.
IN UTERO TRAUMATIC BRAIN INJURY:
CASE REPORT AND LITERATURE REVIEW
O Grassby, C Burford, P Ghimire, J P Lavrador, A Kailaya-Vasan, V Minichini, S Bassi, C Chandler and B Zebian
Introduction
Traumatic brain injury requiring operative
intervention in a neonate as a result of
motor vehicle collision (MVC) whilst in
utero is extremely rare.
There have been only a few reported
cases of brain injury in infants following
in utero trauma as a result of MVC in the
literature.
The infants sustain significant injuries
such as intraventricular haemorrhage,
contusion and sub-arachnoid
haemorrhage and do not survive.
References
1. Sadro CT, Zins AM, Debiec K, Robinson J. Case report: lethal fetal head injury and placental abruption in a pregnant trauma patient. Emerg Radiol. 2012 Apr;19(2):175-80.
2. Breysem L, Cossey V, Mussen E, Demaerel P, Van de Voorde W, Smet M. Fetal trauma: brain imaging in four neonates. Eur Radiol. 2004 Sep;14(9):1609-14. Epub 2004 May 20.
Case Report
Our patient is a child delivered via an
emergency caesarean section at 37+4
weeks due to foetal distress following an
MVC involving his mother.
Low APGHAR at birth (4). Developed
seizures and required phenobarbitone.
CT and MRI head revealed a large right
parietal skull fracture and severe
traumatic brain injury (TBI) with
intraventricular haemorrhage,
subarachnoid blood and a subdural with
subgaleal haematoma.
The patient improved to feeding, moving
all four limbs and crying appropriately but
developed a growing skull fracture
clinically and radiologically (Figure 1)
over a period of weeks.
Repair of growing skull fracture was
performed with dural layer reconstituted
and bony edges apposed. Liquefied
infarcted brain tissue was removed.
There were no neurosurgical concerns
post-operatively.
Literature Review
Our literature review demonstrated that cases of traumatic brain
injury following in utero trauma are extremely rare with only 5 cases
identified.
We identified one case of lethal foetal head injury and placental
abruption, following an MVC. As in this case, an emergency C-
section was performed. However, after failed attempts at
resuscitation the patient was pronounced dead. Post-mortem
analysis indicated a right parietal fracture, with subarachnoid and
subgaleal haemorrhage, as in our case1(Figure 2).
Another case series outlined the pathology in four cases of traumatic
brain injury in neonates following MVC in utero2. Unfortunately, all of
the neonates died despite the mother only experiencing minor trauma
in half of the cases.
Figure 2 a) sagittal and b)
axial reconstruction images
following CT through the
gravid uterus.
Displaced right parietal
fracture with underlying
intracranial haemorrhage is
present 2
CONCLUSION
This case demonstrates the severity of the sequelae following a post-
MVC in-utero traumatic brain injury. Despite this presentation being
rare, it is associated with high mortality and morbidity. Management
may be helped by improved reporting of foetal injury following MVCs.
Figure 1: 3D reconstruction of the growing skull fracture
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