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Germinal Matrix Hemorrhage
Karen L. Salzman, MD; P. Ellen Grant, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Germinal matrix hemorrhage (GMH)
          • Synonyms

            • Grade 4 GMH = periventricular hemorrhagic infarction (PHI)
            • Cerebellar GMH = external granular layer hemorrhage
            • Germinal matrix = ventricular + subventricular zone (SVZ)
          • Definitions

            • Germinal matrix
              • Highly vascular, neural tube-derived structure
                • Dynamic; varies both temporally, spatially
              • Contains multiple cell types
                • Neural stem cells
                • Restricted neural progenitor cells
                • Ependymal cells
                • Premigratory/migrating neurons, glia

          IMAGING

          • General Features

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      Selected References

                                      1. Brouwer AJ et al: Early and late complications of germinal matrix-intraventricular haemorrhage in the preterm infant: what is new? Neonatology. 106(4):296-303, 2014
                                      2. Klebe D et al: Acute and delayed deferoxamine treatment attenuates long-term sequelae after germinal matrix hemorrhage in neonatal rats. Stroke. 45(8):2475-9, 2014
                                      3. Coen RW: Preventing Germinal Matrix Layer Rupture and Intraventricular Hemorrhage. Front Pediatr. 1:22, 2013
                                      4. Okazaki M et al: Delayed germinal matrix hemorrhage induced by ventriculoperitoneal shunt insertion for congenital hydrocephalus. J Neurosurg Pediatr. 12(1):67-70, 2013
                                      5. Del Bigio MR: Cell proliferation in human ganglionic eminence and suppression after prematurity-associated haemorrhage. Brain. 134(Pt 5):1344-61, 2011
                                      6. Tsitouras V et al: Infantile posthemorrhagic hydrocephalus. Childs Nerv Syst. 27(10):1595-608, 2011
                                      7. O'Leary H et al: Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage. Pediatrics. 124(1):302-9, 2009
                                      8. Roze E et al: Risk factors for adverse outcome in preterm infants with periventricular hemorrhagic infarction. Pediatrics. 122(1):e46-52, 2008
                                      9. Volpe JJ. Neurology of the Newborn. 5th ed. Philadelphia, PA: Saunders, 2008
                                      10. Bassan H et al: Neurodevelopmental outcome in survivors of periventricular hemorrhagic infarction. Pediatrics. 120(4):785-92, 2007
                                      11. Kadri H et al: The incidence, timing, and predisposing factors of germinal matrix and intraventricular hemorrhage (GMH/IVH) in preterm neonates. Childs Nerv Syst. 22(9):1086-90, 2006
                                      12. Morioka T et al: Fetal germinal matrix and intraventricular hemorrhage. Pediatr Neurosurg. 42(6):354-61, 2006
                                      13. Folkerth RD: Neuropathologic substrate of cerebral palsy. J Child Neurol. 20(12):940-9, 2005
                                      14. Kinoshita Y et al: Volumetric analysis of the germinal matrix and lateral ventricles performed using MR images of postmortem fetuses. AJNR Am J Neuroradiol. 22(2):382-8, 2001
                                      15. Blankenberg FG et al: Sonography, CT, and MR imaging: a prospective comparison of neonates with suspected intracranial ischemia and hemorrhage. AJNR Am J Neuroradiol. 21(1):213-8, 2000
                                      16. Felderhoff-Mueser U et al: Relationship between MR imaging and histopathologic findings of the brain in extremely sick preterm infants. AJNR Am J Neuroradiol. 20(7):1349-57, 1999
                                      17. Blankenberg FG et al: Neonatal intracranial ischemia and hemorrhage: diagnosis with US, CT, and MR imaging. Radiology. 199(1):253-9, 1996
                                      18. Szymonowicz W et al: Ultrasound and necropsy study of periventricular haemorrhage in preterm infants. Arch Dis Child. 59(7):637-42, 1984
                                      19. Papile LA et al: Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 92(4):529-34, 1978
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Pathology

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Germinal matrix hemorrhage (GMH)
                                              • Synonyms

                                                • Grade 4 GMH = periventricular hemorrhagic infarction (PHI)
                                                • Cerebellar GMH = external granular layer hemorrhage
                                                • Germinal matrix = ventricular + subventricular zone (SVZ)
                                              • Definitions

                                                • Germinal matrix
                                                  • Highly vascular, neural tube-derived structure
                                                    • Dynamic; varies both temporally, spatially
                                                  • Contains multiple cell types
                                                    • Neural stem cells
                                                    • Restricted neural progenitor cells
                                                    • Ependymal cells
                                                    • Premigratory/migrating neurons, glia

                                              IMAGING

                                              • General Features

                                                • CT Findings

                                                  • MR Findings

                                                    • Ultrasonographic Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Staging, Grading, & Classification

                                                              • Gross Pathologic & Surgical Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          Selected References

                                                                          1. Brouwer AJ et al: Early and late complications of germinal matrix-intraventricular haemorrhage in the preterm infant: what is new? Neonatology. 106(4):296-303, 2014
                                                                          2. Klebe D et al: Acute and delayed deferoxamine treatment attenuates long-term sequelae after germinal matrix hemorrhage in neonatal rats. Stroke. 45(8):2475-9, 2014
                                                                          3. Coen RW: Preventing Germinal Matrix Layer Rupture and Intraventricular Hemorrhage. Front Pediatr. 1:22, 2013
                                                                          4. Okazaki M et al: Delayed germinal matrix hemorrhage induced by ventriculoperitoneal shunt insertion for congenital hydrocephalus. J Neurosurg Pediatr. 12(1):67-70, 2013
                                                                          5. Del Bigio MR: Cell proliferation in human ganglionic eminence and suppression after prematurity-associated haemorrhage. Brain. 134(Pt 5):1344-61, 2011
                                                                          6. Tsitouras V et al: Infantile posthemorrhagic hydrocephalus. Childs Nerv Syst. 27(10):1595-608, 2011
                                                                          7. O'Leary H et al: Elevated cerebral pressure passivity is associated with prematurity-related intracranial hemorrhage. Pediatrics. 124(1):302-9, 2009
                                                                          8. Roze E et al: Risk factors for adverse outcome in preterm infants with periventricular hemorrhagic infarction. Pediatrics. 122(1):e46-52, 2008
                                                                          9. Volpe JJ. Neurology of the Newborn. 5th ed. Philadelphia, PA: Saunders, 2008
                                                                          10. Bassan H et al: Neurodevelopmental outcome in survivors of periventricular hemorrhagic infarction. Pediatrics. 120(4):785-92, 2007
                                                                          11. Kadri H et al: The incidence, timing, and predisposing factors of germinal matrix and intraventricular hemorrhage (GMH/IVH) in preterm neonates. Childs Nerv Syst. 22(9):1086-90, 2006
                                                                          12. Morioka T et al: Fetal germinal matrix and intraventricular hemorrhage. Pediatr Neurosurg. 42(6):354-61, 2006
                                                                          13. Folkerth RD: Neuropathologic substrate of cerebral palsy. J Child Neurol. 20(12):940-9, 2005
                                                                          14. Kinoshita Y et al: Volumetric analysis of the germinal matrix and lateral ventricles performed using MR images of postmortem fetuses. AJNR Am J Neuroradiol. 22(2):382-8, 2001
                                                                          15. Blankenberg FG et al: Sonography, CT, and MR imaging: a prospective comparison of neonates with suspected intracranial ischemia and hemorrhage. AJNR Am J Neuroradiol. 21(1):213-8, 2000
                                                                          16. Felderhoff-Mueser U et al: Relationship between MR imaging and histopathologic findings of the brain in extremely sick preterm infants. AJNR Am J Neuroradiol. 20(7):1349-57, 1999
                                                                          17. Blankenberg FG et al: Neonatal intracranial ischemia and hemorrhage: diagnosis with US, CT, and MR imaging. Radiology. 199(1):253-9, 1996
                                                                          18. Szymonowicz W et al: Ultrasound and necropsy study of periventricular haemorrhage in preterm infants. Arch Dis Child. 59(7):637-42, 1984
                                                                          19. Papile LA et al: Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 92(4):529-34, 1978