Cranial ultrasound findings in preterm germinal matrix haemorrhage, sequelae and outcome

Abstract

Germinal matrix-intraventricular haemorrhage (GMH-IVH), periventricular haemorrhagic infarction (PHI) and its complication, post-haemorrhagic ventricular dilatation (PHVD), are still common neonatal morbidities in preterm infants that are highly associated with adverse neurodevelopmental outcome. Typical cranial ultrasound (CUS) findings of GMH-IVH, PHI and PHVD, their anatomical substrates and underlying mechanisms are discussed in this paper. Furthermore, we propose a detailed descriptive classification of GMH-IVH and PHI that may improve quality of CUS reporting and prediction of outcome in infants suffering from GMH-IVH/PHI.

Fig. 1

GMH/IVH: typical postmortem examples.

Fig. 2. GMH/IVH: origin and grading.

GMH starts in a venule that drains into lateral subependymal collector veins; it extends into white matter by virtue of venous compression and infarction; bottom row: T2-weighted MRI of GMH with limited IVH and limited venous infarct.

Fig. 3. GMH/IVH: ultrasound grading.

CUS grading of GMH/IVH; arrowheads point to GMH, arrows to the presence of clot in the ventricle cavity; asterisk is choroid plexus.

Fig. 4. GMH/IVH: indirect signs of IVH and unusual extension into cavum vergae.

Arrowhead points to GMH; asterisk represents clot in midline cavity.

Fig. 5. GMH/IVH: GMH and deep vein relations.

Deep venous anatomy and some Doppler examples; in red circles the typical location of GMH near the caudo-thalamic groove; initially the GMH is often separate from a resulting venous infarct; the two may merge, and extensive lesions can be associated with absent terminal vein drainage.

Fig. 6. GMH/IVH: examples of types of venous infarction.

Examples of different types of venous infarction: thalamostriate (terminal vein), anterior terminal vein (caudate), inferior ventricle vein, medial subependymal (midline) veins, compared with the image of typical posterior frontal developmental venous anomaly (DVA).

Fig. 7

GMH/IVH: evolution to porencephaly.

Fig. 8. GMH/IVH: post-haemorrhagic ventricular dilatation.

Measurements and inspection of dilated ventricles following extensive IVH (* third ventricle with extended protrusions).

Fig. 9. GMH/IVH: Doppler findings.

a Asymmetry in terminal vein size, inversely related to size of ipsilateral direct lateral vein or lateral atrial vein; to be compared with absent terminal vein facing extensive venous infarction. b Apparent enlargement (congestion) of a vein by GMH. c Escape of blood from deep venous infarct along enlarged pial veins, above a Doppler-empty venous space. d Normal deep venous anatomy in GMH without infarction.