Grade IV germinal matrix hemorrhage with periventricular leukomalacia
Presentation
Ex-32 week preterm neonate with neonatal seizures.
Patient Data
Day 11 - screening
Grey-white matter differentiation is preserved. Cortical folding is appropriate for age. Normal echogenicity and homogeneity of the periventricular and subcortical white matter.
Thalami and basal ganglia are normal. Normal ventricular system. No periventricular or intraventricular hemorrhage seen.
Day 25 - neonatal convulsions
There is bilateral germinal matrix hemorrhage that extends into the parenchyma and dilated ventricles (grade IV). Right anterior horn ventricle craniocaudal dimension; 10 mm on the right and 10 mm on the left.
Grey-white matter differentiation is preserved. Cortical folding is appropriate for age.
Normal echogenicity and homogeneity of subcortical white matter. Thalami and basal ganglia are normal. The width of the subarachnoid spaces are appropriate for age. No midline shift.
Day 25 - seizures and sepsis
Extensive intraventricular hemorrhage is seen from the lateral fourth ventricle. The lateral and third ventricles are dilated. Anterior horns of the lateral ventricles measure up to 10 mm. Hemorrhage is also seen within the bilateral centrum semiovale.
Areas of restricted diffusion are seen in the bilateral thalami, left parietal and right temporal lobes in keeping with infarcts.
Extensive brain edema is seen with sulcal effacement. Myelination couldn't be assessed due to extensive brain edema.
Orbital structures are unremarkable.
Day 40
Post placement of an external ventricular drain (EVD).
Re-demonstration of the previously visualized grade IV germinal matrix hemorrhage. Interval increase in the dilatation of the ventricles.
The periventricular regions show extensive multi-cystic regions, right more than left features periventricular leukomalacia (grade IV).
An external ventricular shunt is noted on the left lateral ventricle.
Right anterior lateral ventricle horn measures; 28 mm and 32 mm on the left.
Case Discussion
A case of preterm neonatal convulsions with sepsis. Worsening of interval radiological findings from a normal screening cranial ultrasound on day 11 to extensive periventricular leukomalacia on day 40.
Germinal matrix hemorrhages are a common intracranial complication among infants born before 32 weeks. They originate from the fragile capillary network of the subependymal germinal matrix.
Periventricular leukomalacia is infarction of the brain white matter as a result of neonatal hypoxic ischemic injury. This results in cavitation and periventricular cystic formation.
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