Hydranencephaly in Neonate With Prenatal Exposure to Alcohol During Pregnancy

Hydranencephaly (HE) is a rare congenital condition characterized by near-total absence of the cerebral hemispheres, replaced by cerebrospinal fluid, most commonly resulting from in utero bilateral internal carotid artery occlusion; although maternal alcohol consumption is associated with fetal neurodevelopmental abnormalities, its direct role in HE remains unclear. We report a case of a 42-year-old multiparous woman with chronic alcohol use throughout pregnancy who delivered a female neonate at 40 + 5 weeks via spontaneous vaginal delivery. The neonate presented with facial asymmetry and a boggy parietal swelling, while maintaining intact reflexes and normal muscle tone. Third-trimester ultrasonography had suggested hydrocephalus, and postnatal cranial ultrasonography confirmed extensive cerebral destruction with fluid replacing most brain structures. Laboratory investigations, including TORCH screening, were unremarkable. The infant was managed with supportive care and parental counseling. Hydranencephaly is typically associated with early childhood mortality, although rare cases of prolonged survival have been described. Neuroimaging is essential for differentiating HE from severe hydrocephalus and porencephaly, and management remains largely supportive, with ventriculoperitoneal shunting considered in selected cases. This case highlights the importance of early prenatal detection, multidisciplinary management, and increased awareness of potential alcohol-related fetal brain abnormalities to guide counseling and optimize outcomes.