Prenatal diagnosis of a subdural hematoma associated with reverse flow in the middle cerebral artery: case report and literature review

Abstract

To our knowledge this is the first reported case of a subdural hematoma, related to fetal autoimmune thrombocytopenia, diagnosed prenatally by ultrasound. The underlying etiology was hidden maternal autoimmune thrombocytopenia. This disease, which is as serious as alloimmune thrombocytopenia, causes severe fetal thrombocytopenia, which carries with it a high risk of intracranial hemorrhage and recurrence in subsequent pregnancies. Only 14 cases of fetal subdural hematomas have been reported in the literature. The etiologies of these cases were principally traumatic, or due to disorders of hemostasis. Their prognoses were generally poor, with 50% resulting in fetal death in utero and the remaining 50% demonstrating post-natal sequelae. The presence of reverse flow in the middle cerebral artery is rare and its association with a subdural hematoma unusual. Abnormalities found on cerebral Doppler studies indicate an adaptive response to a fetal condition for which the prognosis is then very poor. Monitoring fetuses at risk for hemorrhage by ultrasound imaging and Doppler studies enables us to detect indicators of a worsening prognosis before the ultrasound appearance of morphological hemorrhage. The development of intracranial hemorrhage raises difficult management issues during the index pregnancy and in subsequent pregnancies.

A Case of Fetal Subdural Hematoma at 31 Weeks of Gestation in a Woman on Warfarin Therapy after Cabrol’s Operation

“…Only 14 cases have been reported in the literature [4]. The etiology of intrauterine subdural hematoma is unknown in many cases, although there are several predisposing risk factors such as fetal or maternal thrombocytopenia, coagulopathies secondary to hemophilia, hepatic disease or hydrops fetalis, and congenital vascular malformation [5,6].…”

Factor X Deficiency Presenting with Bilateral Chronic Subdural Hematoma

“…The incidence of chronic subdural hematomas in children under 1 year of age is higher than in older children [1]. Patients with intrauterine subdural hematomas have been reported [2,3,4,5]. Most pediatric cases are caused by child abuse [1].…”

“…Most pediatric cases are caused by child abuse [1]. Trauma, vitamin K deficiency, thrombocytopenia and other coagulation disorders can lead to subdural hemorrhage [2,4,6,7]. Although factor X has been a well-known etiology for intracranial bleeding, intracranial localizations of hematomas have not been well documented.…”

Fetal Extradural Hematoma: Prenatal Diagnosis and Postmortem Examination

“…A fetal extra-axial hematoma is a rare condition which is generally associated with signifi cant trauma or blood coagulation disorders [1,2] . More than 15 cases of fetal subdural hematomas have been reported in the literature [2,3], but only 1 case of an extradural hematoma without histological data has been previously described [4] .…”

“…More than 15 cases of fetal subdural hematomas have been reported in the literature [2,3], but only 1 case of an extradural hematoma without histological data has been previously described [4] . In this …”