Grade IV germinal matrix haemorrahge with intraventricular extension and hydrocephalus

Case contributed by Dr Mohammad A. ElBeialy


Premature, newborn baby.

Patient Data

Age: Neonate
Gender: Male

Left caudo-thalamic faint hyperdense lesion consistent with germinal matrix hemorrhage with intraventricular extension as well as marked supra- and infra-tentorial hydrocephalus. Left anterior frontal encephalomalacia.   

Marked dilatation of the supra- and infratentorial ventricular system with widening of the basal cisterns, prominent cortical sulci, Sylvian fissures and basal cisterns. compartmentalization of the left frontal horn is also noted. A relatively large area of altered MR signal is seen involving the choroid plexus within the left lateral ventricle displaying predominantly hyperintense T1WI as well as hypointense T2WI rim and hyperintense FLAIR signal with restricted diffusion with hypointense ADC signal (early subacute blood). Another smaller similar intraventricular blood is seen within the right lateral ventricle in dependent location.      

Marked reduction of white matter volume with bilateral cerebral deep white matter and periventricular transependymal interstitial retrograde CSF permeation with left anterior frontal encephalomalacia. No midline shift. No extra axial masses or collections.

Follow-up MRI of the brain shows:

Almost total resolution of the left lateral intraventricular hemorrhage with a resolving ill-defined area of abnormal signal intensity seen within the left caudo-thalamic groove displaying altered MR signal seen with predominantly hyperintense T1WIs and hypointense T2WIs (early subacute blood). Marked dilatation of the supra- and infratentorial ventricular system with compartmentalization of the left frontal horn.

Marked reduction of the cerebral mantle is still noted yet with reduction of the periventricular transependymal CSF permeation. A left frontal area of encephalomalacia is seen as well as irregularity of the ventricular wall.

Case Discussion

Left caudothalamic grade IV germinal matrix hemorrhage with left lateral intraventricular hemorrhage as well as marked communicating supra- and infratentorial hydrocephalus with left frontal encephalomalacia.

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Case information

rID: 42905
Published: 12th Jul 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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