Prenatal diagnosis of a subdural hematoma associated with reverse flow in the middle cerebral artery: case report and literature review

To our knowledge this is the first reported case of a subdural hematoma, re lated to fetal autoimmune thrombocytopenia, diagnosed prenatally by ultraso und. The underlying etiology was hidden maternal autoimmune thrombocytopeni a. This disease, which is as serious as alloimmune thrombocytopenia, causes severe fetal thrombocytopenia, which carries with it a high risk of intrac ranial hemorrhage and recurrence in subsequent pregnancies. Only 14 cases o f fetal subdural hematomas have been reported in the literature. The etiolo gies of these cases were principally traumatic, or due to disorders of hemo stasis. Their prognoses were generally poor, with 50% resulting in fetal de ath in utero and the remaining 50% demonstrating post-natal sequelae. The p resence of reverse flow in the middle cerebral artery is rare ant its assoc iation with a subdural hematoma unusual. Abnormalities found on cerebral Do ppler studies indicate an adaptive response to a fetal condition for which the prognosis is then very poor. Monitoring fetuses at risk for hemorrhage by ultrasound imaging and Doppler studies enables us to detect indicators o f a worsening prognosis before the ultrasound appearance of morphological h emorrhage. The development of intracranial hemorrhage raises difficult mana gement issues during the index pregnancy and in subsequent pregnancies.