Fact-sheet: Neonatal intracranial hemorrhage

Updated on 08/26/2020 at 2:17 PM

Note : 10/10 ( 2 notes )

Definition

Pathophysiology:

→ Intraventricular hemorrhage: why is it so common in premature newborns?

premature infant++:
immaturity of the cerebral parenchyma and of the muscular fibers of the cerebral arterioles
rich vascularization of the germinal zones: thalamocaudate groove and germinal matrix
= area of the brain adjacent to the ventricular floor
highly active++ during fetal development, disappearing around the 35th week of gestation.
Thin blood vessels vulnerable to variations in blood flow, which can lead to rupture or bleeding
more frequent metabolic disorders
hypoxia due to respiratory distress

--> hence systematic screening for IVH in premature infants++

- may present with no initial symptoms++ hence the rationale for systematic screening

rapid increase in head circumference if stage 3 from the outset (with ventricular dilatation)!
seizures
anemia (drop in hemoglobin)
hypotension
acidosis

Transfontanellar Ultrasound +++ (TFU)

- blood = intracranial hyperechogenicity (around or within the ventricles ++)

- location of the hemorrhage (cf classification)

grade 1: subependymal hemorrhage hemorrhage of the thalamocaudate groove on parasagittal view++
grade 2: intraventricular hemorrhage remember to check the occipital horn on parasagittal view
to look for hyperechoic filling of the occipital horn (indeed, material sedimenting at the bottom of the occipital horn cannot be choroid plexus)
grade 3: IVH + ventricular dilatation ventricular dilatation is defined as: on coronal view, at the mid-height of the choroid plexus, lateral ventricle width > 10mm or
Levene ventricular index: coronal view at the level of the foramina of Monro
distance between the midline (falx cerebri) and the outer border of the anterior horn of the lateral ventricle
hydrocephalus if > 97th percentile (approximately 10 to 12 mm
Evans index maximal width of the frontal horn of the LV / maximal biparietal diameter > 0.3
callosal angle < 90°
Grade 4: IVH + dilatation + intraparenchymal hematoma hyperechoic intraparenchymal hematoma

COMPLICATIONS:

Hydrocephalus
Ventriculitis (hyperechogenicity and thickening of the ventricular wall due to ependymal inflammation)
Edema followed by parenchymal atrophy due to partial destruction
cavitation (anechoic) communicating with the ventricle
Volpe infarction: hemorrhagic venous infarction
due to compression and thrombosis of the terminal veins of the white matter by a grade 4 IVH
hyperechoic
(external angle of the lateral ventricle) considered as a grade 4 IVH

Not in preterm infants! Consider MRI++ if ventricular shunting is being considered

Prognosis:

Treatment:

PAPILE CLASSIFICATION