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29 weeker female
birth weight 1174 g
Mother 33 year G3P1+1
Underlying hypertension with superimposed
PE
• EmLSCS
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birth asphyxia
APGAR 21, 55, 710
Bag and mask ventilation
Chest compression
NS bolus
adrenaline
Resuscitation 10 minutes
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Irregular respiration
Intubated and ventilated
CXR RDS G-IV
surfactant
• Metabolic acidosis
• HCO3 correction 3 times
• Anaemia
• Packed cell
• Hypocalcemia
• Ca gluconate
• IVH G-II on day 4
• Feeding intolerance on day 9 and day 19
• Treated as NEC 2 times
Porencephalic cyst
Porencephalic cyst
• cystic lesion of the brain due to an
encephaloclastic insult (e.g. intrauterine
infections and ischemia), lined by white
matter, which communicates with the
ventricles and/or the subarachnoid space
Clinical presentation
• Variable
• range from asymptomatic, to profoundly
impaired
• Present in the first year of life
• common early manifestations are spasticity and
seizures
• Language impairment, mental retardation, and
motor deficits
• Head circumference may be normal or small, or
enlarged.
Pathology
• typically lined by white matter.
• occur from focal encephalomalacia due to a
localized cerebral insult most frequently
during early gestation.
• Gliosis will develop if the insult is after the
start of the third trimester
• insults as early as 20 weeks of gestation may
result in gliosis
Etiology
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perinatal cerebral ischemia
trauma
infection
antenatal intraparenchymal hemorrhage
familial porencephaly: mutations in the
COL4A1 gene leading to fragile blood vessels
causing antenatal/perinatal hemorrhagic
strokes
Diagnosis
• Neuroimaging
– Ultrasound
– CT
– MRI
Types
• Type I: unilateral, due to hemorrhage or
ischemia.
• Type II: bilateral, due to neuronal migration
disruption
Treatment and prognosis
• supportive.
• The extent of impairment is somewhat related
to the size and location of the lesion.
References
• Hamidi, H. and Ho, M. (n.d.) Porencephaly.
Available from:
https://radiopaedia.org/articles/porencephaly
[accessed 31st May 2019].
• The Fetal Medicine Centre (2019)
Porencephalic cyst. Available from:
https://fetalmedicine.com/education/fetalabnormalities/brain/porencephalic-cyst
[accessed 31st May 2019].