14 day old infant born at 29 weeks of gestation with E. Coli sepsis, seizure, and coagulopathy; now with decreased respiratory drive and fixed pupils. There is extensive predominantly T1 hyperintense hemorrhage diffusely within the cerebellum and within portions of the brainstem, as well as within the effaced fourth ventricle, particularly along the choroid plexus. There is substantial superior transtentorial herniation of the cerebellum with diffuse restricted diffusion and compression of the brainstem. There is also extensive predominately T1 hyperintense hemorrhage within the third and fourth ventricles, particularly along the choroid plexus. There is marked dilatation of the third and bilateral lateral ventricles. Furthermore, there are areas of T1 hyperintensity and susceptibility effect involving portions of the bilateral basal ganglia, particularly in the caudothalamic grooves bilaterally, and along the bilateral lateral ventricular margins. There is diffuse lack of cerebral myelination and paucity of cortical folding. The major cerebral flow voids are intact. There is caput succedaneum that measures up to 10 mm in thickness. There are bilateral middle ear effusions. There appears to be mild staphylomatous deformity of the bilateral globes.
1. Extensive subacute hemorrhage in the posterior fossa and throughout the ventricular system, as well as along the lateral ventricular margin, including in the region the the germinal matrices bilaterally, with associated superior transtentorial cerebellar heliation, ischemia, and obstructive hydrocephalus.2. Diffuse lack of cerebral myelination and paucity of cortical folding is likely related to prematurity. Discussed with Dr. Singh at 10:10 AM on 7/13/16.