Neonatal Forearm Compartment Syndrome: Look for Cerebral Stroke

A male term newborn presented with a neonatal forearm compartment syndrome together with an ipsilateral cerebral stroke. Pregnancy and delivery were uneventful, except for oligohydramnios. His mother had celiac disease and hypothyroidism. Since birth, he showed a 4-cm bullous-ulcerated lesion on the left volar forearm and elbow fold (, A), with normal pulses, and an ipsilateral upper limb paresis with reduced motility, dropped wrist, no fingers extension, and grasping. Tendon reflexes were normal with Babinski sign bilaterally evident. Radiography showed a mild carpus asymmetry (left < right). Echocardiogram and upper limbs Doppler ultrasound scan were negative. Brain magnetic resonance imaging revealed a left-sided encephalomalacic lesion in the middle cerebral artery territory (, B). No pre-perinatal infectious disorders history was detected. Complete blood count, C reactive protein, and full coagulation profile were normal. At 3 months of age, he had motor delay (Bayley Scale Performance Development Index = 70), mild axial hypotonia, decreased muscle tone on the left arm and slightly increased on the right side, and asymmetry in knee reflexes (right > left). He had a residual scar on the forearm. Electroencephalogram background activity showed decreased amplitude on the left hemisphere, with sharp waves in the left centro-parietal regions (, C).
Source: The Journal of Pediatrics - Category: Pediatrics Authors: Tags: Insights and Images Source Type: research