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Multicystic encephalomalacia in a surviving monochorionic twin
Y H Chou1, K I Tsou Yau, P J Wang
1Department of Pediatrics, National Taiwan University Hospital, Taipei, R.O.C.
Zhonghua Minguo Xiao Er Ke Yi Xue Hui Za Zhi [Journal]. Zhonghua Minguo Xiao Er Ke Yi Xue Hui
|November 1, 1993
Summary
A monochorionic diamniotic twin experienced neurological complications after its co-twin’s intrauterine demise. Disseminated intravascular coagulation (DIC) from fetal-to-fetal transfer is the suspected cause.
Area of Science:
- Neonatal Neurology
- Perinatology
- Fetal Medicine
Background:
- Monochorionic diamniotic twin pregnancies carry unique risks.
- Intrauterine fetal demise of one twin can impact the surviving neonate.
Observation:
- A male neonate delivered via Cesarean section presented with generalized tonic seizures.
- Initial brain imaging was normal, but follow-up revealed diffuse cerebral hemisphere low density.
- At one month, cystic encephalomalacia was evident; by four months, the infant showed spasticity and neurodevelopmental delay.
Findings:
- The surviving twin developed severe neurological deficits post-intrauterine fetal demise.
- Imaging demonstrated progressive brain injury, including cystic encephalomalacia.
- Disseminated intravascular coagulation (DIC) secondary to fetal-to-fetal thromboplastic material transfer was implicated.
Implications:
- This case highlights the potential for severe neurological sequelae in surviving twins following intrauterine demise.
- Understanding fetal-to-fetal transfer mechanisms is crucial for managing these high-risk pregnancies.
- Prompt recognition and management of DIC and hypoxic-ischemic insult are vital for optimizing outcomes.