Background Perinatal infratentorial haemorrhage (PIH) is a rare birth complication associated with abnormal labour.
Case presentation A baby boy was born by vacuum extraction at 41 weeks’ gestational age. The pregnancy was uneventful and Apgar scores were 3/6/9. Following initial resuscitation, insufficient and irregular breathing, non-reactive pupils and absence of spontaneous movements were noted. A diagnosis of perinatal asphyxia with hypoxic–ischaemic encephalopathy (HIE) was considered. Therapeutic hypothermia (TH) for 72 hours was initiated. Cerebral ultrasound showed only a mildly hyperechogenic periventricular substance. A brain MRI on the fourth day of life revealed a subdural haemorrhage in the posterior fossa with compression of the fourth ventricle.
Conclusion PIH is an important differential diagnosis to HIE that can be missed with ultrasound. PIH is a treatable condition but may be aggravated by TH. Therefore, in neonates at risk for PIH, a more detailed ultrasound protocol or brain MRI should be considered early.
- neonatal and paediatric intensive care
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Contributors BH wrote the first draft of this manuscript and submitted the manuscript after corrections and final approval. RKV provided the neuroradiological images and the design of the figures. BW assisted in planning of the first draft and did a critical revision of the manuscript. SB provided neuropaediatric expertise and supervised corrections of the manuscript.
Competing interests None declared.
Patient consent Guardian consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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