Extensive hemicerebral damage after traumatic midterm amniocentesis

Abstract

We present a 28-year-old right-handed male who, at 17 weeks gestation, suffered a traumatic amniocentesis, and was subsequently born with extensive right-sided cerebral, cerebellar and brainstem damage. The initial amniocentesis was abandoned and repeated 2 weeks later, with normal results, subsequent prenatal ultrasound scans were normal. The patient had an uncomplicated delivery at term, however a complete right sided ptosis and marks on the right parietal region of the scalp were noted. By 4 months of age, a right sided third nerve palsy, a left sided hemiplegia and left visual field defect had been identified, and infantile spasms developed, which were treated successfully with ACTH. No further seizures occurred until habitual seizures began at 7 years of age, consisting of focal seizures with, and without, loss of awareness, with blank spells, abdominal discomfort, head turning, agitation and disorientation. Although initially controlled with antiseizure medication, seizures became refractory within 3 years, occurring several times per day despite extensive medications and vagal nerve stimulation. In recent months, atonic seizures developed, characterised by sudden weakness of the lower limbs causing collapse, not associated with loss of consciousness, with risk of injury and a significant effect on his quality of life. There have not been secondarily generalized tonic-clonic seizures. He achieved undergraduate level education and can walk despite a left hemiparesis.