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Pediatrics
Diagnosis
Brain
Pathology-Based Diagnoses
Stroke
Germinal Matrix Hemorrhage
Germinal Matrix Hemorrhage
Luke L. Linscott, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Germinal matrix hemorrhage (GMH)

          • Synonyms

            • Germinal matrix bleed, preterm caudothalamic hemorrhage, GMH-intraventricular hemorrhage (IVH)

          • Definitions

            • Hemorrhage that occurs in very specific, richly vascular, stress-sensitive areas of brain
            • Germinal matrix has developed into more sturdy blood vessels by 34 weeks of gestation

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • MR Findings

                • CT Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    Selected References

                                    1. Klebe D et al: Posthemorrhagic hydrocephalus development after germinal matrix hemorrhage: established mechanisms and proposed pathways. J Neurosci Res. ePub, 2019
                                    2. Coskun Y et al: A clinical scoring system to predict the development of intraventricular hemorrhage (IVH) in premature infants. Childs Nerv Syst. 34(1):129-36, 2018
                                    3. Poryo M et al: Ante-, peri- and postnatal factors associated with intraventricular hemorrhage in very premature infants. Early Hum Dev. 116:1-8, 2018
                                    4. Hinojosa-Rodríguez M et al: Clinical neuroimaging in the preterm infant: diagnosis and prognosis. Neuroimage Clin. 16:355-68, 2017
                                    5. Reubsaet P et al: The impact of low-grade germinal matrix-intraventricular hemorrhage on neurodevelopmental outcome of very preterm infants. Neonatology. 112(3):203-10, 2017
                                    6. Lu H et al: Risk factors for intraventricular hemorrhage in preterm infants born at 34 weeks of gestation or less following preterm premature rupture of membranes. J Stroke Cerebrovasc Dis. 25(4):807-12, 2016
                                    7. Yilmaz U et al: Superficial siderosis after germinal matrix hemorrhage. AJNR Am J Neuroradiol. 37(12):2389-91, 2016
                                    8. Fumagalli M et al: From germinal matrix to cerebellar haemorrhage. J Matern Fetal Neonatal Med. Suppl 1:2280-5, 2015
                                    9. Hefti MM et al: A century of germinal matrix intraventricular hemorrhage in autopsied premature infants: a historical account. Pediatr Dev Pathol. 19(2):108-14, 2015
                                    10. Raets MM et al: Neonatal disorders of germinal matrix. J Matern Fetal Neonatal Med. 28 Suppl 1:2286-90, 2015
                                    11. Ramenghi LA: Germinal matrix-intraventricular haemorrhage: still a very important brain lesion in premature infants! J Matern Fetal Neonatal Med. 28 Suppl 1:2259-60, 2015
                                    12. Ballabh P: Pathogenesis and prevention of intraventricular hemorrhage. Clin Perinatol. 41(1):47-67, 2014
                                    13. 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
                                    14. Ingram MC et al: Poor correlation between head circumference and cranial ultrasound findings in premature infants with intraventricular hemorrhage. J Neurosurg Pediatr. 14(2):184-9, 2014
                                    15. Intrapiromkul J et al: Accuracy of head ultrasound for the detection of intracranial hemorrhage in preterm neonates: comparison with brain MRI and susceptibility-weighted imaging. J Neuroradiol. 40(2):81-8, 2013
                                    16. Strahle J et al: Mechanisms of hydrocephalus after neonatal and adult intraventricular hemorrhage. Transl Stroke Res. 3(Suppl 1):25-38, 2012
                                    17. Arrigoni F et al: Deep medullary vein involvement in neonates with brain damage: an MR imaging study. AJNR Am J Neuroradiol. 32(11):2030-6, 2011
                                    18. Behjati S et al: Incidence of hydrocephalus and the need to ventriculoperitoneal shunting in premature infants with intraventricular hemorrhage: risk factors and outcome. Childs Nerv Syst. 27(6):985-9, 2011
                                    19. Bassan H: Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol. 36(4):737-62, v, 2009
                                    20. Roze E et al: Risk factors for adverse outcome in preterm infants with periventricular hemorrhagic infarction. Pediatrics. 122(1):e46-52, 2008
                                    21. 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
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Pathology

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Germinal matrix hemorrhage (GMH)

                                            • Synonyms

                                              • Germinal matrix bleed, preterm caudothalamic hemorrhage, GMH-intraventricular hemorrhage (IVH)

                                            • Definitions

                                              • Hemorrhage that occurs in very specific, richly vascular, stress-sensitive areas of brain
                                              • Germinal matrix has developed into more sturdy blood vessels by 34 weeks of gestation

                                            IMAGING

                                            • General Features

                                              • Ultrasonographic Findings

                                                • MR Findings

                                                  • CT Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Staging, Grading, & Classification

                                                            • Gross Pathologic & Surgical Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      Selected References

                                                                      1. Klebe D et al: Posthemorrhagic hydrocephalus development after germinal matrix hemorrhage: established mechanisms and proposed pathways. J Neurosci Res. ePub, 2019
                                                                      2. Coskun Y et al: A clinical scoring system to predict the development of intraventricular hemorrhage (IVH) in premature infants. Childs Nerv Syst. 34(1):129-36, 2018
                                                                      3. Poryo M et al: Ante-, peri- and postnatal factors associated with intraventricular hemorrhage in very premature infants. Early Hum Dev. 116:1-8, 2018
                                                                      4. Hinojosa-Rodríguez M et al: Clinical neuroimaging in the preterm infant: diagnosis and prognosis. Neuroimage Clin. 16:355-68, 2017
                                                                      5. Reubsaet P et al: The impact of low-grade germinal matrix-intraventricular hemorrhage on neurodevelopmental outcome of very preterm infants. Neonatology. 112(3):203-10, 2017
                                                                      6. Lu H et al: Risk factors for intraventricular hemorrhage in preterm infants born at 34 weeks of gestation or less following preterm premature rupture of membranes. J Stroke Cerebrovasc Dis. 25(4):807-12, 2016
                                                                      7. Yilmaz U et al: Superficial siderosis after germinal matrix hemorrhage. AJNR Am J Neuroradiol. 37(12):2389-91, 2016
                                                                      8. Fumagalli M et al: From germinal matrix to cerebellar haemorrhage. J Matern Fetal Neonatal Med. Suppl 1:2280-5, 2015
                                                                      9. Hefti MM et al: A century of germinal matrix intraventricular hemorrhage in autopsied premature infants: a historical account. Pediatr Dev Pathol. 19(2):108-14, 2015
                                                                      10. Raets MM et al: Neonatal disorders of germinal matrix. J Matern Fetal Neonatal Med. 28 Suppl 1:2286-90, 2015
                                                                      11. Ramenghi LA: Germinal matrix-intraventricular haemorrhage: still a very important brain lesion in premature infants! J Matern Fetal Neonatal Med. 28 Suppl 1:2259-60, 2015
                                                                      12. Ballabh P: Pathogenesis and prevention of intraventricular hemorrhage. Clin Perinatol. 41(1):47-67, 2014
                                                                      13. 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
                                                                      14. Ingram MC et al: Poor correlation between head circumference and cranial ultrasound findings in premature infants with intraventricular hemorrhage. J Neurosurg Pediatr. 14(2):184-9, 2014
                                                                      15. Intrapiromkul J et al: Accuracy of head ultrasound for the detection of intracranial hemorrhage in preterm neonates: comparison with brain MRI and susceptibility-weighted imaging. J Neuroradiol. 40(2):81-8, 2013
                                                                      16. Strahle J et al: Mechanisms of hydrocephalus after neonatal and adult intraventricular hemorrhage. Transl Stroke Res. 3(Suppl 1):25-38, 2012
                                                                      17. Arrigoni F et al: Deep medullary vein involvement in neonates with brain damage: an MR imaging study. AJNR Am J Neuroradiol. 32(11):2030-6, 2011
                                                                      18. Behjati S et al: Incidence of hydrocephalus and the need to ventriculoperitoneal shunting in premature infants with intraventricular hemorrhage: risk factors and outcome. Childs Nerv Syst. 27(6):985-9, 2011
                                                                      19. Bassan H: Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol. 36(4):737-62, v, 2009
                                                                      20. Roze E et al: Risk factors for adverse outcome in preterm infants with periventricular hemorrhagic infarction. Pediatrics. 122(1):e46-52, 2008
                                                                      21. 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