Deep Medullary Thrombosis

on May 10, 2019

This case involved a newborn infant that was diagnosed with significant neurological problems shortly after birth. MRI scans revealed several sites of hemorrhage deep within the brain and the plaintiffs alleged that this brain injury was caused by the vacuum extractor utilized by the doctor during delivery. Our client claimed that these areas of hemorrhage presented in a classic distribution seen in cases of deep medullary thrombosis and that the hemorrhages developed well before birth.

The challenge was to create a presentation that would explain the location and function of the deep medullary veins and to show how blockages of these veins leads to small areas of hemorrhage in specific regions of the brain. Also, it would be valuable to incorporate the actual MRI films from this case so it is clear that the hemorrhages are directly linked to the blockages of the venous system. Trial Exhibits found a solution to make the truth understandable.

The Trial Exhibits solution was to create a 3D view of the head and brain of a newborn infant and to remove portions of the brain to allow for a clear view of the complex venous network within. Once the anatomy had been established, we animated flow through the veins showing how the tiny medullary veins carry blood away from the deep tissues of the brain. Next, an enlarged view of one representative vein allowed us to animate the formation of a blood clot and how this thrombus effectively stops flow through the vein. As a result of these tiny blockages, we animated the development of the small areas of hemorrhage typical of these blockages. Once the regions of hemorrhage had been established, we rotated our image and faded to a view of the actual MRI from this case showing that film evidence clearly supports this theory of deep medullary thrombosis.

Click here you view the video on our YouTube page