Neonatal intraventricular hemorrhage - grade 3 and 4

Case contributed by Dr Yoshi Yu

Presentation

Preterm premature rupture of membranes at 27 weeks gestation. Nuchal cord at delivery with poor APGAR scores requiring intubation.

Patient Data

Age: 4 day old
Gender: Male

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 hemorrhage on the right and grade 3 on the left). No periventricular cystic changes are evident.

Case Discussion

This case demonstrates extensive germinal matrix hemorrhage resulting in intraventricular hemorrhage in the newborn.

On the right there is intraventricular hemorrhage associated with abnormally increased right periventricular cerebral parenchymal echogenicity due to secondary venous infarct within the cerebral parenchyma (grade 4). There is no abnormal periventricular cerebral parenchymal echogenicity on the left, but hydrocephalus is present (grade 3).

Germinal matrix hemorrhage is very common in premature neonates born prior to 32 weeks of gestation and becomes increasingly rare after 32 weeks. It occurs due to vascularity of the germinal matrix during embryogenesis. The major risk factor is prematurity, rather than a necessarily traumatic birth. In grade 4 intraventricular hemorrhage, liquefaction of hematoma within the periventricular cerebral parenchyma over time results in cystic changes and formation of porencephaly.

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