Fetal brain intraventricular hemorrhage

Case contributed by Ghada Sheta


36 WG pregnant, ultrasound revealed ventriculomegaly

Patient Data

Age: 35 years
Gender: Female

 The brain shows supratentorial (4th ventricle is normal) hydrocephalic changes reaching about 4 cm at the level of right atrium with markedly dilated both occipital horns (colpocephaly) . 

The right choroid plexus is enlarged ( measuring 4.2 x 1.2 cm), shows cystic changes , extending to the frontal horn and cerebral parenchyma in the fronto-pareital regions. It elicits rim of bright signal in T1WI, intermediate in T2WI with evident restricted diffusion. Normal left choroid plexus

Agenesis of corpus callosum manifested by colpocephaly, parallel arrangement of lateral ventricles and absent precentral gyrus.

Normal posterior fossa structures.

Case Discussion

Findings are suggestive of intraventricular hemorrhage with extension to the adjacent brain parenchyma and secondary hydrocephalic changes ( grade IV germinal matrix hemorrhage). 

Germinal matrix usually disappears after 32 weeks of gestations and hence persists in premature children. It has weak blood vessels which in response to ischemia rupture leading to hemorrhage. The hemorrhage may be localized at subependymal region (Grade I) or extends to the lateral ventricles without hyrocephalus (Grade II) or with hydrocephalus (Grade III) or extends to brain parenchyma (Grade IV).

In this case, during seemingly uneventful pregnancy, fetal GMIVH was suspected to occur at approximately 30-33 weeks of gestation, with the absence of any known factor predisposing to fetal hemorrhage. Prenatal MRI is a must in cases of hemorrhage to predict neurodevelopmental prognosis of the fetal brain. 

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