PMC10350874_01
a, b Antenatal ultrasound: antenatal ultrasound on the day of delivery showing crescent hyperechoic collection suggestive of SDH 8 x 1.2 cm (dotted lines 1 and 2).
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F1
Cardiotocography demonstrated instability of fetal heart rate, and an ultrasound revealed crescent hyperechoic collection measuring 8 x 1.2 cm suggestive of SDH (shown in Fig. 1).
First brain ultrasound: brain ultrasound on day 1 of life showing crescent shape hypoechoic collection in the left frontoparietal region measuring 5 x 0.7 cm suggestive of SDH with overlying echogenic area probably denoting layering of the hematoma. An echogenic focus was seen in the falx measuring 1.7 x 0.8 cm which could be clotted blood. No midline shift or ventricular dilatation was noted.
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F2
Brain ultrasound was done on day 1 of life (shown in Fig. 2), which showed crescent shape hypoechoic collection in the left frontoparietal region measuring 5 x 0.7 cm, suggestive of SDH with overlying echogenic area denoting layering of the hematoma.
Testes ultrasound: testes ultrasound on day 1 of life showing large turbid fluid collection in the right scrotal sac, most probably hemorrhagic fluid measuring around 25 x 15 mm. Normal appearance and perfusion of both testes are seen.
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F3
Ultrasound for testes (shown in Fig. 3) showed a large turbid fluid collection in the right scrotal sac which was most probably hemorrhagic, measuring around 25 x 15 mm.
a-f Head computed tomography (CT) scan: head CT on day 2 of life showing significant bilateral SDH surrounding almost the whole left hemisphere with extension to the tentorium and posterior interhemispheric fissure as well as the occipital horn of the right lateral ventricle. Also, linear hyperdense lesions are seen extending along the cerebral cortical sulci likely representing associated subarachnoid hemorrhage. Diffuse hypodense area involving both hemispheres almost entirely, suggesting diffuse brain edema with shifting of the midline structures at least 6 mm to the right.
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F4
In addition, computed tomography scan of the head (shown in Fig. 4) was done on the second day of life and showed significant bilateral SDH surrounding almost the whole left hemisphere with extension to the tentorium and posterior interhemispheric fissure as well as the occipital horn of the right lateral ventricle.
a-c Brain ultrasound at 20 days of life: brain ultrasound on day 20 of life showing large subacute/chronic SDH overlying the left cerebral hemisphere with the largest pocket measuring 5.9 x 2.8 (cross dotted black lines) with midline shift to the right side. Large cystic changes involving both cerebral hemispheres suggestive of severe PVL and changes suggestive of cephalomalacia and dilated lateral ventricles were observed.
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F5
Brain ultrasound was repeated at 20 days of life (shown in Fig. 5) and showed large subacute/chronic SDH overlying the left cerebral hemisphere with the largest pocket measuring 5.9 x 2.8 cm with midline shift to the right side.
a, b Head MRI: head MRI at day 24 of life showing large bilateral acute on subacute SDH. Features of extensive encephalomalacia changes are noted involving the cerebral hemispheres with small areas being spared in the basal ganglionic region and in the frontotemporal area. The posterior fossa structures are also noted to be spared.
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F6
At the age of 24 days, magnetic resonance imaging (MRI) (shown in Fig. 6) was done and showed large bilateral acute on subacute SDH.
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