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Term Neonate with Atypical Hypoxic-Ischemic Encephalopathy Presentation: A Case Report
Nick Townley1, Emily McNellis1, Venkatesh Sampath1
1Division of Neonatology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.
AJP Reports
|August 31, 2017
Summary
A neonate experienced atypical hypoxic-ischemic encephalopathy (HIE) due to umbilical vein thrombosis. This rare case highlights the link between umbilical vascular issues and severe neonatal brain injury with refractory seizures.
Area of Science:
- Neonatal Neurology
- Perinatal Pathology
- Vascular Malformations
Background:
- Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal brain injury.
- Umbilical cord complications can lead to adverse perinatal outcomes.
- Normal pregnancy and delivery do not preclude rare vascular events.
Observation:
- A neonate presented with continuous bicycling movements and burst suppression on electroencephalogram.
- Brain MRI revealed diffuse cerebral cortical/subcortical diffusion restriction, indicative of hypoxic-ischemic injury.
- Pathology identified focal umbilical vein thrombosis compressing an umbilical artery, causing dissection and hematoma.
Findings:
- The case demonstrates an atypical presentation of HIE in a neonate.
- Umbilical vein thrombosis was the likely cause of the hypoxic-ischemic injury.
- The vascular event was associated with refractory seizures.
Implications:
- This case underscores the importance of considering umbilical vascular thrombosis in neonates with unexplained HIE and seizures.
- It expands the understanding of potential causes for neonatal hypoxic-ischemic encephalopathy.
- Early diagnosis and management of umbilical vascular events may improve neonatal outcomes.
