# Spontaneous Right Thalamic Hemorrhage With Intraventricular Extension in a Two-Month-Old Preterm Infant Initially Suspected of Having Cow’s Milk Protein Allergy

## TL;DR

A preterm infant showed neurological symptoms and was found to have a rare brain hemorrhage, initially suspected to be due to a milk allergy but later managed successfully.

## Contribution

This case report adds a rare clinical observation of spontaneous thalamic hemorrhage in a preterm infant.

## Key findings

- A two-month-old preterm infant presented with neurological symptoms and was diagnosed with right thalamic hemorrhage.
- The infant's condition was initially suspected to be cow's milk protein allergy but was later attributed to a hemorrhagic infarct.
- The child recovered fully and showed normal development at follow-up.

## Abstract

Nontraumatic spontaneous intracerebral hemorrhage in infants is rare and usually occurs due to infection, trauma, or known coagulopathy, most often originating from the thalamus and extending into the ventricle. In this case report, we describe a two-month-old late preterm female infant (36 weeks of gestational age) who was brought in due to irritability, projectile vomiting, and feeding difficulties. The clinical history suggested cow's milk protein allergy, as the baby had recently been switched to formula. The neurological signs observed during physical examination, including upward eye deviation and lack of visual tracking, prompted neuroimaging, which revealed a right thalamic hemorrhagic infarct with intraventricular hemorrhage. The patient was stabilized and transferred to the local tertiary neurosurgical center. Workup for thrombophilia and vascular malformations was initiated. The child recovered uneventfully and demonstrated normal developmental status at follow-up.