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Updated: Jul 12 2018

Germinal Matrix and Intraventricular Hemorrhage

  • Snapshot
    • A 2-day-old girl presents for multiple seizure episodes and is admitted to the neonatal intensive care unit. She was born to a 23-year-old woman at 29 weeks gestation via a spontaneous vaginal delivery. On physical exam, there is altered consciousness, hypotonia, a bulging anterior fontanelle, decreased spontaneous movement, and cyanosis. Cranial ultrasonography demonstrates a germinal matrix and intraventricular hemorrhage.
  • Introduction
    • Definition
      • hemorrhage within the germinal matrix and/or ventricles
  • Epidemiology
    • Risk factors
      • prematurity (< 37 weeks)
        • extremely premature infants (28 weeks) are at greatest risk
      • low birth weight (< 1,500 g)
  • Pathogenesis
    • Prematurity does not provide adequate structural support for the germinal matrix
      • this increases the risk of the germinal matrix to hemorrhage
  • Presentation
    • Symptoms
      • seizures
      • altered consciousness
    • Physical exam
      • hypotonia
      • decreased or absent spontaneously or elicited movement
      • bulging anterior fontanelle
      • systemic hypotension
  • Imaging
    • Cranial ultrasonography
      • indication
        • initial imaging modality of choice
  • Differential
    • Periventricular leukomalacia
      • differentiating factors
        • periventricular white matter echodensity and white matter cysts on imaging
  • Treatment
    • Medical
      • phenobarbital
        • indication
          • used in the treatment of seizure in newborns
  • Complications
    • Cerebral palsy
    • Cognitive impairment
    • Neurodevelopmental delay
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