Perinatal infratentorial haemorrhage: a rare but possibly life-threatening condition.

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. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.