July 10th, 2020

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Traumatic Subdural Hemorrhage in One Fetus of a Twin Pregnancy: A Case Report
Authors:  Ali Alhousseini, M.D., Hunter Gomez-Roberts, M.D., Aya Fawaz, Susan Berman, M.D., Swati Mody, M.D., and Karoline S. Puder, M.D.
BACKGROUND: In utero subdural hemorrhage (SDH) has not previously been reported in 1 fetus of a twin gestation. Postnatal reports of SDH have been associ­ated with both traumatic and nontraumatic etiologies.

CASE: A 19­year­old wom­an, G 1 P 0, presented with a
diamniotic­dichorionic preg­nancy at 29­6/7 weeks’ ges­tation for a growth scan. The patient reported a his­tory of 2 assault events with abdominal trauma around 2 weeks prior to the ultra­ sound. Fetus 2 was found to be breech with the head close to the anterior uter­ine wall. Ultrasound detected a large left subdural col­lection of mixed echogenicity, consistent with SDH, and right ventriculomegaly with encephalomalacia of the right occipital lobe. Biparietal diameter and head circumference were both transiently greater than the 95th percentile. Fetus 1 was cephalic with normal in­ tracranial anatomy. At 35 weeks the patient presented with preterm labor and delivered by cesarean birth. Neo­natal imaging confirmed the findings, but neurologic deficits were not identified in the neonatal period. MRI at 12 months showed resolution of the hemorrhage and stable cystic encephalomalacia involving the right parietal and occipital lobes, with associated ex vacuo porencephalic dilation of the right lateral ventricle. At 18 months of age the baby was able to ambulate with support, with no reported seizure.

CONCLUSION: This ante­ natal diagnosis of SDH in a twin pregnancy is likely related to the reported abu­sive trauma to the patient, with discordant findings be­ tween the twins due to fetal position.
Keywords:  hemorrhage, non-accidental, prenatal, subdural, trauma, ultrasound
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