title: Skew ocular deviation: a catastrophic sign on MRI of fetal glioblastoma.
abstract: METHODS
  We report the prenatal observation of fetal ocular skew deviation in a case of a glioblastoma found prenatally at 33 weeks' gestation by MRI. The fetal MRI, obtained by half-Fourier single-shot turbo spin echo (HASTE) pulse sequences, showed a tumor (80 mm in maximum diameter) in the right deep cerebral hemisphere with extension to the mid-cranial fossa and tentorial hiatus in addition to severe hydrocephalus. On coronal MR images a vertical dysconjugated gaze was recognized. One week after the MRI, frequent delayed deceleration prompted an emergency cesarean section. The baby was born with left hemiparesis and central neurogenic hyperventilation, which evolved into decerebrate rigidity and apneustic breathing within 2 h. Post-mortem examination revealed a glioblastoma in the right deep hemisphere, a tumor with brain stem involvement, and transtentorial herniation.
  
  
  CONCLUSIONS
  We suggest, therefore, that recognition of ocular skew deviation on fetal MR images would indicate brain stem involvement and poor postnatal prognosis. Early recognition of the catastrophic sign would lead to proper management.
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, No 201, Sec 2, 11217, Taipei, Taiwan, Republic of China.
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Chuang
authors.forename: Wan-Yuo
authors.initials: WY
authors.lastname: Guo
authors.forename: Donald Ming-Tak
authors.initials: DM
authors.lastname: Ho
authors.forename: Tai-Tong
authors.initials: TT
authors.lastname: Wong
authors.forename: Jeng-Hsiu
authors.initials: JH
authors.lastname: Hung
authors.forename: Shu-Jen
authors.initials: SJ
authors.lastname: Chen
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Sheu
authors.forename: Cheng-Yen
authors.initials: CY
authors.lastname: Chang
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000150:complications* / Q000151:congenital* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis; D005909:Glioblastoma / Q000150:complications* / Q000151:congenital* / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008279:Magnetic Resonance Imaging; D015835:Ocular Motility Disorders / Q000175:diagnosis* / Q000209:etiology*; D011247:Pregnancy; D011296:Prenatal Diagnosis