Denouement and Discussion: Intrauterine Stab Wound to the Head of a 29-Week Fetus
Figure 1. Cranial sonographic scan on day 1 of life. The coronary section reveals a right intracerebral hemorrhage with a clearly visible incision channel (about 5-6 cm) stretching as far as 1 cm beyond the falx cerebri and a subdural hematoma on the right.
Figure 2. Cranial sonographic scan on day 55 of life. The sagittal section shows the right choroid plexus nearly completely cut off by the knife.
Figure 3. Cranial computed tomographic scan on day 1 of life. Hyperdensity is seen in the bleeding zone, with the incision channel from the right and a subdural hematoma.
To our knowledge, this is the first case of infant survival after an intrauterine stab injury. After cesarean delivery, aggressive management prevented severe asphyxia. An intraventricular hemorrhage resulted from the penetrating injury; compression of the hematoma may have prevented secondary damage.
Intrauterine gunshot wounds reported by Buchsbaum and coworkers1-4 and Edner et al5 did not result in extensive intracranial hemorrhage. Martin and Gussack6 reported on penetrating craniocerebral injuries with ventricular system involvement. All infants consequently showed neurologic defects. Hiebsch et al7 found a poor prognosis in infants with intraventricular hemorrhage.
In our patient the first neurologic deficit was noted at 8 months as a slowly increasing contralateral hemiparesis and hemihypsarrhythmia observed on electroencephalogram (without clinical convulsions).
This case demonstrates (1) how an intrauterine intracranial injury in a premature neonate at 29 weeks' gestation can be cared for through intensive neonatal treatment and (2) the importance of performing cranial sonography in the follow-up of neurologic defects in infancy. Sonography is the imaging modality of choice in infants with injuries or diseases of the central nervous system as it determines localization, size, and change in the process and improves early recognition and therapy for complications such as subdural hematoma and hydrocephalus.
Accepted for publication April 20, 1998.
Corresponding author: Beverly P. Wood, MD, KAM 211, University of Southern California School of Medicine, 1975 Zonal Ave, Los Angeles, CA 90033.
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