Giant transient dural sinus dilatation with neonatal nuchal cord
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".