A Newborn With a Mass on the Brain

Presentation

A male newborn is born after 38 weeks of gestation by elective caesarean section to a 28-year-old gravida 4, para 3 female. The newborn’s parents are first-degree cousins ​​without a significant family history. The maternal history is unremarkable. She received prenatal care at an outpatient clinic and the scan obtained at about 24 weeks of pregnancy is normal. She presented to the emergency department at 36 weeks gestation with a history of impaired fetal movement and was later admitted to the labor and delivery unit for evaluation. The maternal laboratory findings are as follows: hepatitis B, negative; group B Streptococcus, negative; blood group, O positive; antibodies, negative. Bedside ultrasound shows macrocephaly with a large calcified central intracranial heterogeneous mass with peculiar vascularity of 7.74 × 6.55 × 8.37 cm3 in the supratentorial midline region, with brain tissue being replaced by thinning of the brain parenchyma. The infratentorial structure is normal and no other fetal abnormalities are seen (Figure 1). The mother refused fetal magnetic resonance imaging (MRI).

Figure 1.

Antenatal ultrasound of the fetal head with macrocephaly, showing a head circumference of 39.73 cm (yellow arrow) and a large irregular calcified central intracranial heterogeneous mass (red stars) with peculiar vascularity (green arrow).

At delivery, the neonate’s Apgar scores are 7 and 9 at 1 and 5 minutes, respectively. His vital signs are stable (temperature, 98°F [36.7°C]; heart rate, 150 beats/min; respiratory rate, 60 breaths/min; blood pressure, 66/41 mm Hg; oxygen saturation, 94%), but an initial examination of the neonate reveals macrocephaly with severed sutures, sunset eyes, over-head scaling and no other obvious dysmorphic features (Figure 2).

Figure 2.

Macrocephaly with sunken eyes (anteroposterior/lateral view).

The birth weight of the child is 4,130 g (88th percentile), length 56 cm (99th percentile) and head circumference 48…

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