What imaging findings are seen in a grade 1 germinal matrix haemorrhage?
Haemorrhage limited to the subependymal region at the caudothalamic grooves (germinal matrix). Imaging findings can be very subtle and often difficult to distinguish from physiologic irregularity of the choroid plexuses.
How is a grade 3 germinal matrix differentiated from grade 2?
Presence of ventricular dilatation. Typically (but not always), grade 2 would fill less than 50% of the lateral ventricles.
What are the symptoms and signs of germinal matrix haemorrhage?
Grade I and II are typically asymptomatic or present with vague symptoms and carry a better prognosis. Grade III and IV typically have severe neurological compromise such as apnoea, seizures, and bulging fontanelles.
How is germinal matrix haemorrhage differentiated from hypoxic ischaemic encephalopathy of the newborn on ultrasound?
Hypoxic ischaemic encephalopathy typically affects the periventricular white matter (periventricular leukomalacia). Early findings show abnormally increased or asymmetrical periventricular echnogenicity. It later evolves to cystic changes (porencephaly).
Abnormally dilated lateral ventricles containing echogenic debris, in keeping with blood products. The echogenic debris is more extensive within the right lateral ventricle compared to left with extension into the right periventricular cerebral parenchyma (grade 4 haemorrhage on the right and grade 3 on the left). No periventricular cystic changes are evident.