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Brain/Spine » Neonatal Brain
Germinal matrix hemorrhage, Grade I
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Presentation This 30 weeks preterm female neonate presented with respiratory distress but no neurological symptoms.  A neonatal brain ultrasound was ordered.
 
 
 
Caption: Coronal view of the brain at the level of frontal horns of lateral ventricles and foramina of Monro
Description: Bilateral hyperechoic nodules seen compressing the frontal horns of lateral ventricles bilaterally.
 
 
 
Caption: Comparison of previous ultrasound plane with anatomic section.
Description: Bilateral hyperechoic nodules are seen compressing the frontal horns of the lateral ventricles. A prominent cavum septi pellucidi is seen between the lateral ventricles and the corpus callosum can be seen crossing midline above the cavum and below the cingulate gyrus. The anatomic section shown for comparison is a slightly more posterior plane through the anterior region of the third ventricle. Anatomic section courtesy of Dr. Pilu and Dr. Jeanty (theFetus.net). See http://sonoworld.com/fetus/page.aspx?id=73
 
 
 
Caption: Right parasagittal view for the brain at the level of the right caudothalamic groove
Description: Hyperechoic nodule seen in the region of caudothalamic groove on right side elevating the floor of the lateral ventricle, with no intraventricular extension of the hemorrhage.
 
 
 
Caption: Left parasagittal view for the brain at the level of the left caudothalamic groove.
Description: Hyperechoic nodule seen in the region of caudothalamic groove on left side elevating the floor of the lateral ventricle, with no intraventricular extension of the hemorrhage.
 
 
 
Caption: Coronal view for the brain at the level of frontal horns of lateral ventricles and foramina of Monro. (high frequency probe)
Description: Bilateral hyperechoic nodules seen compressing the frontal horns of lateral ventricles bilaterally.
 
 
 
Caption: Right parasagittal view for the brain at the level of the right caudothalamic groove. (high frequency probe)
Description: Hyperechoic nodule seen in the region of caudothalamic groove on right side elevating the floor of the lateral ventricle, with no intraventricular extension of the hemorrhage.
 
 
 
Caption: Left parasagittal view for the brain at the level of the Left caudothalamic groove. (high frequency probe)
Description: Hyperechoic nodule seen in the region of caudothalamic groove on left side elevating the floor of the lateral ventricle, with no intraventricular extension of the hemorrhage.
 
Differential Diagnosis Germinal matrix hemorrhage vs other possible causes of respiratory distress.
 
Final Diagnosis Bilateral acute germinal matrix hemorrhage grade I
 
Discussion
The germinal matrix (GM) is the birthplace of the cortical neurons before they migrate along the radial glia toward the cortical ribbon. It extends along the entire ventricle early during embryonic life before progressively involuting with advancing gestational age (GA). The last area of the GM to involute is at the region of the caudothalamic groove; it is no longer well visualized by 35 weeks GA (Yikilmaz A,Taylor GA 2008).
Because the GM is a large, highly vascular structure with little architectural support in its immature capillary bed, GMH is a frequent finding in the neonatal period ( Lucca J, Baldisserotto M 2013).
The first classification strategy of intracranial hemorrhage was developed by Papile et al. based on CT studies in 1978.  Grade 1 referred to hemorrhage confined to the GM, grade 2 described GMH with extension of the hemorrhage into a normal sized ventricular system. Intra-ventricular hemorrhage (IVH) with ventricular dilatation defined grade 3, and grade 4 was distinguished by parenchymal hemorrhage (Papile LA et al. 1978).
US images show GMH grade 1 as focal hyper-echogenic nodular or rounded lesions in the caudothalamic notches. On follow up, the hemorrhage retracts and becomes progressively well-defined and hypo-echogenic. On late follow-up, the hemorrhage can disappear completely (Gupta AK et al. 1993).

 
Case References
  1. Yikilmaz A, Taylor GA. Cranial sonography in term and near-term infants. Pediatr Radiol 2008;38:605-616.
  2. Lucca J, Baldisserotto M. Cerebral ultrasound findings in infants exposed to crack cocaine during gestation. Pediatr Radiol 2013;43:212218.
  3. Papile LA, Burstein J, Burstein R, et al. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529534. 
  4. Gupta AK, Anand NK, Lamba IM. Ultrasonic evaluation of neonatal subependymal-intraventricular hemorrhage and its complications. Indian J Pediatr 1993;60:11-18.

 
Technical Details
Ultrasound scanner: Toshiba.
Transducers: Micro-convex 6 MHz Array and 7.5 MHz Linear Array.
 
Follow Up The general condition of the baby worsened and unfortunately she died shortly after.
 
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