Germinal matrix hemorrhage (grading)

Last revised by Rohit Sharma on 17 Jan 2024

Grading of germinal matrix hemorrhage has taken several forms over the years. The most commonly used system is the sonographic grading system proposed by Burstein, Papile, et al. 


  • grade I

    • restricted to subependymal region/germinal matrix which is seen in the caudothalamic groove

    • overall good prognosis 4

    • 3.1% mortality 7

  • grade II

    • extension into normal-sized ventricles and typically filling less than 50% of the volume of the ventricle

    • overall good prognosis 4

    • 7.8% mortality 7

  • grade III

    • extensive hemorrhage with distension/dilation of the ventricles

    • 21.3% mortality 7

  • grade IV

    • parenchymal involvement

    • 36.1% mortality 7

It was initially postulated that grade IV IVH represented parenchymal extension of ventricular hemorrhage. It is now recognized that grade IV IVH represents parenchymal hemorrhage secondary to venous infarction caused by compression of deep terminal veins by an expanded ventricle filled with blood.

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