Skew ocular deviation: a catastrophic sign on MRI of fetal glioblastoma.
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.
Chuang
Yu-Ming
YM
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.
Guo
Wan-Yuo
WY
Ho
Donald Ming-Tak
DM
Wong
Tai-Tong
TT
Hung
Jeng-Hsiu
JH
Chen
Shu-Jen
SJ
Sheu
Ming-Huei
MH
Chang
Cheng-Yen
CY
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