Germinal Matrix Hemorrhage (GMH)

• Intraventricular hemorrhage is a common, unfortunate outcome in low-birth weight, preterm neonates.
• The primary cause of intraventricular hemorrhage is rupture of germinal matrix vessels. The germinal matrix is thick layer of highly vascularized, immature cells that are prone to rupture and extravasation of blood into the subependymal zone.
• The germinal matrix is fed by the the recurrent artery of Heubner and lateral striate artery.
• GMH typically arises at the caudothalamic groove in the basal ganglia (but the germinal matrix extends beyond this region). This shallow groove lies at the level of the foramina of Monro and projects into the floor of the lateral ventricle.
• GMH is often bilateral. When blood pours out of the foramina of Luschka (and forms subarachnoid hemorrhage), the foramina of Luschka can become plugged, blocking CSF outflow, and producing hydrocephalus (ventricular dilatation).
• Grade 3 GMH involves ventricular dilatation.
• Grade 4 involves hemorrhage extension in the parenchyma, itself.
• GMH typically occurs within the first 3 days after birth (80–90% of cases) but it can occur prenatally, as well.

• Approximately 63,000 US infants are born preterm and with very low birth weight (<1,500 grams)
• 20-25% of them suffer from GMH (of any kind)
• 10-15% of them suffer from severe GMH (grades 3 or 4 GMH)

Severe GMH typically causes severe neurological deficits or death (90% of Grade IV GMH are fatal).

• GMH is associated with hyaline membrane disease (respiratory distress syndrome).

• Grade I: hemorrhage confined to the germinal matrix.
• Grade II: intraventricular hemorrhage without ventricular dilatation
• also defined as involving < 50% of the lateral ventricular space
• Grade III: intraventricular hemorrhage with ventricular dilatation
• also defined as involving > 50% of the lateral ventricular space
• Grade IV (aka periventricular hemorrhagic infarction): GMH with hemorrhage into the surrounding parenchyma

• Bigio, Del, and Marc R. “Cell Proliferation in Human Ganglionic Eminence and Suppression after Prematurity-Associated Haemorrhage.” Brain 134, no. 5 (May 1, 2011): 1344–61. https://doi.org/10.1093/brain/awr052.

• Bowie, Jd, Dr Kirks, Er Rosenberg, and Mr Clair. “Caudothalamic Groove: Value in Identification of Germinal Matrix Hemorrhage by Sonography in Preterm Neonates.” American Journal of Roentgenology 141, no. 6 (December 1983): 1317–20. https://doi.org/10.2214/ajr.141.6.1317.

• Hinojosa-Rodríguez, Manuel, Thalía Harmony, Cristina Carrillo-Prado, John Darrell Van Horn, Andrei Irimia, Carinna Torgerson, and Zachary Jacokes. “Clinical Neuroimaging in the Preterm Infant: Diagnosis and Prognosis.” NeuroImage?: Clinical 16 (August 14, 2017): 355–68. https://doi.org/10.1016/j.nicl.2017.08.015.

• Hong, Hyun Sook, and Ji Ye Lee. “Intracranial Hemorrhage in Term Neonates.” Child’s Nervous System 34, no. 6 (June 2018): 1135–43. https://doi.org/10.1007/s00381-018-3788-8.

McCrea, Heather J., and Laura R. Ment. “The Diagnosis, Management and Postnatal Prevention of Intraventricular Hemorrhage in the Preterm Neonate.” Clinics in Perinatology 35, no. 4 (December 2008): 777–vii. https://doi.org/10.1016/j.clp.2008.07.014.

• Moretti, Raffaella, Julien Pansiot, Donatella Bettati, Nathalie Strazielle, Jean-François Ghersi-Egea, Giuseppe Damante, Bobbi Fleiss, Luigi Titomanlio, and Pierre Gressens. “Blood-Brain Barrier Dysfunction in Disorders of the Developing Brain.” Frontiers in Neuroscience 9 (2015). https://doi.org/10.3389/fnins.2015.00040.

• Procianoy, R S, J A Garcia-Prats, J M Adams, A Silvers, and A J Rudolph. “Hyaline Membrane Disease and Intraventricular Haemorrhage in Small for Gestational Age Infants.” Archives of Disease in Childhood 55, no. 7 (July 1, 1980): 502–5. https://doi.org/10.1136/adc.55.7.502.

• Volpe, Joseph J. “Brain Injury in Premature Infants: A Complex Amalgam of Destructive and Developmental Disturbances.” Lancet Neurology 8, no. 1 (January 2009): 110–24. https://doi.org/10.1016/S1474-4422(08)70294-1.

• ———. “Brain Injury in Premature Infants: A Complex Amalgam of Destructive and Developmental Disturbances.” Lancet Neurology 8, no. 1 (January 2009): 110–24. https://doi.org/10.1016/S1474-4422(08)70294-1.

• Wigglesworth, J S, I H Keith, D J Girling, and S A Slade. “Hyaline Membrane Disease, Alkali, and Intraventricular Haemorrhage.” Archives of Disease in Childhood 51, no. 10 (October 1976): 755–62.