An Unexpected Brain Lesion in a 2-month-old Infant

Prenatal and Birth Histories

• Born to a 37-year-old gravida 2, para 0, white woman with negative results on prenatal screening. The father was healthy. The parents were in a nonconsanguineous relationship. The family history was unremarkable, including lack of neurologic disorders.

• Maternal history significant for Hashimoto thyroiditis.

• Pregnancy was uneventful until 28+5 weeks’ gestation, when intrauterine growth restriction and absent diastolic flow were detected on routine ultrasonography. The woman was admitted to the hospital for monitoring and received 2 doses of betamethasone before delivery.

• Estimated gestational age at delivery: 31+3 weeks.

• Cesarean delivery because of nonreassuring fetal heart rate.

• Apgar scores: 7, 9 and 9 at 1, 5 and 10 minutes, respectively.

• Birthweight 1,085 g (6th percentile); birth length 37.5 cm (5th percentile), birth head circumference 27 cm (10th percentile).

Presentation

The male infant was admitted to the NICU where he remained until age 41 days, (37+1 weeks’ postmenstrual age) primarily because of feeding immaturity. During his hospitalization, he had the following diagnoses: prematurity, growth restriction, very-low birthweight, hyaline membrane disease, and angioma of the nose. The initial cranial ultrasonography (at 31+5 weeks, 32+3 weeks and 34+6 weeks’ postmenstrual age) did not show any abnormalities (Fig 1). The infant was doing well at home without any concerns about feeding or infections. At 2 months of age (40 weeks’ postmenstrual age), the outpatient follow-up cranial …