Germinal matrix hemorrhage is a bleeding into the sub

ependyma The ependyma is the thin neuroepithelial ( simple columnar ciliated epithelium) lining of the ventricular system of the brain and the central canal of the spinal cord. The ependyma is one of the four types of neuroglia in the central nervous syst ...

germinal matrix In anatomy, the germinal matrix is a highly cellular and highly vascularized region in the brain out from which cells migrate during brain development. The germinal matrix is the source of both neurons and glial cells and is most active between 8 an ...

with or without subsequent rupture into the

lateral ventricle The lateral ventricles are the two largest ventricles of the brain and contain cerebrospinal fluid (CSF). Each cerebral hemisphere contains a lateral ventricle, known as the left or right ventricle, respectively. Each lateral ventricle resemble ...

. Such

intraventricular hemorrhage Intraventricular hemorrhage (IVH), also known as intraventricular bleeding, is a bleeding into the brain's ventricular system, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. It can result from phys ...

can occur due to

perinatal asphyxia Perinatal asphyxia (also known as neonatal asphyxia or birth asphyxia) is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain. ...

in preterm neonates.

Presentation

This may lead to various neurological sequelae including presentation with cerebral palsy, mental retardation and seizures.

Pathophysiology

The germinal matrix is the site of proliferating neuronal and glial precursors in the developing brain, which is located above the

caudate nucleus The caudate nucleus is one of the structures that make up the corpus striatum, which is a component of the basal ganglia in the human brain. While the caudate nucleus has long been associated with motor processes due to its role in Parkinson's d ...

, in the floor of the

, and caudothalamic groove. The germinal matrix contains a rich network of fragile thin-walled blood vessels. Hence the microcirculation in this particular area is extremely sensitive to hypoxia and changes in perfusion pressure. It is most frequent before 35 weeks gestation and is typically seen in very low birth-weight (<1500g) premature infants, because they lack the ability for auto regulation of cerebral blood flow. Consequently, increased arterial blood pressure in these blood vessels leads to rupture and hemorrhage into germinal matrix.

Diagnosis

Grades

A commonly used classification system of germinal matrix hemorrhage is the sonographic grading system proposed by Papile: *grade I - hemorrhage is confined to the germinal matrix. *grade II - intraventricular hemorrhage without ventricular dilatation *grade III - intraventricular hemorrhage with ventricular dilatation *grade IV - intraventricular rupture and hemorrhage into the surrounding white matter In the grading system proposed by Papile the grad 4 hemorrhages results from a subependymal bleeding into the adjacent brain parenchyma. Today however these bleedings are regarded as venous hemorrhagic infarctions. This is a result of veins compressed by the subependymal bleeding.

Prevention

Antenatal corticosteroids have a role in reducing incidence of germinal matrix hemorrhage in premature infants.

Management

Stem cell-based therapies may help to treat germinal matrix hemorrhage in preterm babies but there is currently no reliable evidence to support their use.

References

External links

{{Certain conditions originating in the perinatal period Neurotrauma Disorders causing seizures Neonatology