Giant transient dural sinus dilatation with neonatal nuchal cord
Notice bibliographique
Résumé
This male child was born at term via an emergency cesarean section with symptoms of fetal distress manifested by reduced movements, abnormal heart rate, Apgar scores of 1 and 6, and an arterial cord pH of 6.93. A tight double nuchal cord was noticed that was immediately released. Stabilization included positive pressure ventilation with 100% oxygen, inhaled nitric oxide, and hypothermia for neuroprotection. No evidence of placental abruption or fetal–maternal hemorrhage was observed, and his hemoglobin level was 108 g/l (see Image 1). After 72 h of therapeutic hypothermia with continuous electroencephalogram surveillance without seizures, no hypoxic changes were detected in the cranial magnetic resonance imaging (MRI), but there was an unexpectedly marked dilatation of the intracranial sinuses, a finding that has not been reported in post-hypothermia neonates.1Walsh B.H. Neil J. Morey J. Yang E. Silvera M.V. Inder T.E. et al.The frequency and severity of magnetic resonance imaging abnormalities in infants with mild neonatal encephalopathy.J Pediatr. 2017; 187: 26-33Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar Follow-up imaging confirmed the absence of any underlying intracranial vascular malformation and normalization of the sinus calibers within 2 weeks of life. Coinciding with a secondary onset of focal seizures on day 12 of life, a new straight sinus thrombus and bilateral frontoparietal cortical areas of restricted diffusion were detected. At the age of 12 months, he exhibited moderate developmental delay. This case highlights a dramatic consequence of intracerebral blood stasis presumed to be caused due to a tight nuchal cord. This theory is supported by the observation of anemia caused due to fetoplacental transfusion along with umbilical vein compression, concurrent placental histology findings such as chorionic vessel dilatation, and strangulation pathomechanism.2Peesay M. Cord around the neck syndrome.BMC Pregnancy Childbirth. 2012; 12: A6Crossref PubMed Scopus (7) Google Scholar Once a critical distension is reached, sinus dural support may hinder the resolution.3Katz M.E. Bass W.T. White L.E. Dural sinus ectasia after prolonged nuchal cord encirclement.J Ultrasound Med. 1992; 11: 289-292Crossref PubMed Scopus (4) Google Scholar Cases with fetal intrauterine venous sinus ectasia have been described in the setting of venous confluence thromboses or a vein of Galen malformation, which should be carefully excluded.4Komiyama M. Kitano S. Sakamoto H. Ehara E. Miyagi N. Kusuda S. Rapid normalization of marked dilatation of the cerebral duro-venous system in a newborn infant mimicking a great vein of Galen varix.Pediatr Neurosurg. 2001; 35: 149-152Crossref PubMed Scopus (6) Google Scholar Due to dilatation of intracranial capacitance vessels, giant dural sinuses may cause considerable brain compression, disseminated intravascular coagulation, and cardiac failure. The natural evolution of this condition is characterized by stratified thrombus formation with slow spontaneous regression up to 1 year, including a generally favorable outcome.5Jenny B. Zerah M. Swift D. Le Tohic A. Merzoug V. Alvarez H. et al.Giant dural venous sinus ectasia in neonates.J Neurosurg Pediatr. 2010; 5: 523-528Crossref PubMed Scopus (19) Google Scholar This case study highlights a potentially clinically underrecognized consequence of neonatal nuchal cord that may result in adverse consequences.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».