Intracranial fetal hemorrhage due to choroid plexus papilloma

Abstract

Various pathologies may trigger cerebral hemorrhage during the fetal period. Intracranial hemorrhages (ICH) are very rare occurrences and intracranial papilloma can be a cause of ICH. This case concerns a 34-year-old healthy pregnant woman who had no significant medical history and whose initial ultrasound exams revealed normal fetal anatomy and growth. An ultrasound scan at 36 weeks revealed a 35×22 mm tumor in the interior of the right posterior horn (Fig. 1). The tumor was hyperechogenic with an irregular surface and perilesional vascularization. No obstruction to the ventricular system was found. The peak flow speed from the medium cerebral artery was 1.5 MoM for the age of gestation. A diagnosis of an intraventricular tumor was made, compatible with choroid plexus papilloma. Consensus was reached to end gestation via cesarean delivery to prevent a secondary hemorrhage during natural childbirth. At 37 weeks of pregnancy a male neonate was delivered weighing 2885 g, with an Apgar score of 9/10 and an arterial pH of 7.29. The newborn was admitted to the neonatal intensive care unit where cranial MRI and cranial ultrasound were carried out. This revealed a large mass in the right lateral ventricle and associated cysts that had displaced the cerebral parenchyma to the frontal region (Figs. 2 and 3). Cerebral arteriography was carried out, followed by embolization and a right temporal craniotomy and complete removal of the mass. The infant currently has normal neurologic development and is progressing well. ICH is observed in utero as hyperechogenic cerebral images on ultrasound [1]. It is usually associated with various maternal medical histories such as thrombocytopenia, hemorrhagic diathesis, or hypertension in pregnancy [2]. ICH caused by a choroid plexus papilloma is rare [2,3]. Diagnosis is made during ultrasound examinations and various manifestations can be identified, such as encephalic parenchyma, hyperechogenic lesions, ventriculomegaly, and periventricular leucomalacia, which may lead to development of severe hydrocephalus and seriously impact neurological development [1,2,4]. This wide range of ultrasoundmanifestations of the damage caused by ICH is an indication of the number of possible prognoses. Nuclear magnetic resonance imaging is the next step in diagnosing these lesions. In cases of ICH, the intensity of the image in T1 is increased compared with the healthy brain tissue, which can contribute to the diagnosis [1].