A newborn baby with a lump on the brain

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Presentation

A male newborn was born at 38 weeks gestation by elective cesarean section to a 28-year-old gravida 4, para 3 woman. The parents of the newborn are first cousins ​​with no significant family history. Maternal history is unremarkable. She received antenatal care at a polyclinic and the CT scan obtained at about 24 weeks gestation is normal. She presented to the emergency department at 36 weeks gestation with a history of decreased fetal movement and was subsequently admitted to the labor and delivery unit for evaluation. Maternal laboratory results are as follows: hepatitis B, negative; group B Streptococcus, negative; blood group, O positive; antibody, negative. Bedside ultrasound shows macrocephaly with a large heterogeneous calcified central intracranial mass of specific vascularity measuring 7.74 × 6.55 × 8.37 cm3 in the middle supratentorial region, replacing brain tissue with thinning of the brain parenchyma. The subtentorial structure is normal and no other fetal abnormalities are observed (Fig. 1). The mother refused fetal magnetic resonance imaging (MRI).

Figure 1.

Antenatal ultrasound of the fetal head showing macrocephaly, with a head circumference of 39.73 cm (yellow arrow) and a large irregular calcified central intracranial heterogeneous mass (red stars) with particular vascularity (green arrow).

At delivery, the newborn’s Apgar scores are 7 and 9 at 1 and 5 minutes, respectively. His vital signs are stable (temperature, 98 ° F [36.7°C]; heart rate, 150 beats / min; respiratory rate, 60 breaths / min; blood pressure, 66/41 mm Hg; oxygen saturation, 94%, but an initial neonatal examination reveals macrocephaly with separate sutures, recumbent eyes, peeling of the skin above the head, and no other evident dysmorphic features (Fig 2).

Figure 2.

Macrocephaly with sunken eyes (anteroposterior / lateral view).

The infant’s birth weight is 4,130 g (88th percentile), length 56 cm (99th percentile), and head circumference 48 …


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