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NEUROIMAGE
Year : 2019  |  Volume : 67  |  Issue : 6  |  Page : 1566-1567

Late-onset Hemorrhagic Disease of a Newborn Mimicking an Atypical Teratoid/Rhabdoid Tumor


1 Division of Pediatric Neurology, Department of Pediatrics and In-charge Child Development Centre, KAHER's J N Medical College, Belgaum, Karnataka, India
2 Department of Pediatric Neurology and Child Development Centre, KLES PK Hospital, Belgaum, Karnataka, India
3 Department of Radiology, KAHER's J N Medical College, Belgaum, Karnataka, India

Date of Web Publication20-Dec-2019

Correspondence Address:
Dr. Mahesh Kamate
Department of Paediatric Neurology, KAHER's J N Medical College, Belgaum - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.273655

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How to cite this article:
Kamate M, Detroja M, Hattiholi V. Late-onset Hemorrhagic Disease of a Newborn Mimicking an Atypical Teratoid/Rhabdoid Tumor. Neurol India 2019;67:1566-7

How to cite this URL:
Kamate M, Detroja M, Hattiholi V. Late-onset Hemorrhagic Disease of a Newborn Mimicking an Atypical Teratoid/Rhabdoid Tumor. Neurol India [serial online] 2019 [cited 2020 Jul 5];67:1566-7. Available from: http://www.neurologyindia.com/text.asp?2019/67/6/1566/273655




Brain tumors in children are common in the first two years of their life. The location of the tumor and magnetic resonance imaging characteristics including spectroscopy and contrast enhancement can give important clues to the final diagnosis.[1],[2] Calcification and bleeding can be seen in some tumors like atypical teratoid/rhabdoid tumor (ATRT) which has universal poor prognosis. On T1-weighted MRI, the tumor mass is typically isointense with frequent hyperintense foci secondary to intratumoral hemorrhage. Hyperintensities are noted on T2W/FLAIR images. Half of them are supratentorial and can occur in the cerebral hemispheres. They have the characteristics of restricted diffusion, edema, necrosis and calcification.[3]

Late hemorrhagic disease of newborn (HDN) can present in a varied fashion in children with subarachnoid hemorrhage, subdural hemorrhage, parenchymal bleed and intraventricular bleed. Most cases present with bleeding in more than one site.[4] We report a 3-month-old boy who presented with a cluster of right-sided focal motor seizures whose non-contrast MRI of the brain showed a lesion in the left temporal lobe that was iso-hyperintense on T1W and hyperintense on T2W/FLAIR [Figure 1]a and [Figure 1]b. It was heterogeneous in nature and was reported as an intracranial tumor most likely Primitive neuroectodermal tumor/ATRT. However, there was no calcification and necrosis within the mass. The child was asymptomatic on presentation and a repeat MRI with susceptibility weighted imaging (SWI) was performed [Figure 1]c. The SWI sequence clearly demonstrated a bleed and the possibility of late HDN was considered. The child was given vitamin K and antiepileptic drugs continued. A repeat scan after 2 months showed near complete resolution with residual gliosis [Figure 1]d, [Figure 1]e, [Figure 1]f. Thus, a benign diagnosis was made in a child referred to us as a case of ATRT.
Figure 1: (a and b) T1W, T2W axial section of the brain at the level of midbrain at presentation showing heterogenous hyperintense lesion in the left temporal lobe respectively; (c) Susceptibility weighted image (SWI) showing hypointensity in the lesion suggestive of hemorrhage; (d-f) T1W, T2W and Susceptibility weighted image (SWI) axial section of the brain at the level of midbrain at two months follow-up showing near complete resolution of the lesion with residual gliosis, respectively

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To conclude, when we have a lesion or a space-occupying lesion with edema or hemorrhage in young infants, we should consider late hemorrhagic disease of newborn as a possibility, work up for HDN in the form of prothrombin time, activated partial thromboplastin time estimation and treat with vitamin K injection. Most of the time pediatricians draw their conclusions from the report issued by the radiologists due to their lack of training. This misdiagnosis has financial implications and puts significant stress on the parents of the children with the actually benign condition. A careful review of the evidence including a CT scan and MR spectroscopy paired with treatment with vitamin K and follow-up neuroimaging can show resolution of the lesion. This is the preferred modality for confirming the diagnosis of benign late HDN in an infant.

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Di Rocco C, Iannelli A, Ceddia A. Intracranial tumors of the first year of life. A cooperative survey of the 1986-1987 Education Committee of the ISPN. Childs Nerv Syst. 1991;7:150-3.  Back to cited text no. 1
    
2.
Larouche V, Huang A, Bartels U, Bouffet E. Tumors of the central nervous system in the first year of life. Pediatr Blood Cancer. 2007;49 (7 Suppl):1074-82.  Back to cited text no. 2
    
3.
Meyers SP, Khademian ZP, Biegel JA, Chuang SH, Korones DN, Zimmerman RA. Primary intracranial atypical teratoid/rhabdoid tumors of infancy and childhood: MRI features and patient outcomes. AJNR Am J Neuroradiol. 2006;27:962-71.  Back to cited text no. 3
    
4.
Aydinli N, Citak A, Calişkan M, Karaböcüoglu M, Baysal S, Ozmen M. Vitamin K deficiency--late onset intracranial haemorrhage. Eur J Paediatr Neurol. 1998;2:199-203.  Back to cited text no. 4
    


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