Thursday, August 26, 2010
Germinal matrix hemorrhage
Findings
Hyperechogenic mass like hemorrhage into the right caudothalamic groove with ventricular extension, extension into the septum pellucidum, and resultant hydrocephalus; Grade 3 intraventricular germinal matrix hemorrhage.
Diagnosis: Germinal matrix hemorrhage
Key points
Risks for germinal matrix hemorrhage:
- Less than 32 weeks gestational age
- Under 1500g
- 20-25% risk in premature, low birth weight infant
Germinal matrix
- Proliferating cells; lines the periventricular spaces of the lateral ventricles and third ventricle
- Largest at 24-26 weeks, then involutes
- Begins involuting at the level of the third ventricle
- Involuted completely at 36 weeks
Mechanisms behind germinal matrix hemorrhage-
- Venous bleed
- From cardiovascular instability from lack of autoregulatory mechanism in the preterm infant
- Watershed bleed
- Nearly exclusively occurs in the first 1 wk of life, 50% on day 1
- Identifying and grading germinal matrix hemorrhage
- Blood is always as dense as choroid plexus
- Classic hemorrhage in the caudothalamic groove looks like a mass. May extend into the ventricles
Classification:
- Grade 1: Classic case caudothalamic groove looks like a mass
- Grade 2: Intraventricular extension, usually no long term sequelae
- Grade 3: Dilated ventricles
- Grade 4: Parenchyma, actually from venous hemorrhagic infarct
Labels:
AuntMinnie,
Pediatric,
Vascular
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment