Germinal matrix hemorrhage

Germinal matrix hemorrhage is a bleeding into the subependymal germinal matrix with or without subsequent rupture into the lateral ventricle. Such intraventricular hemorrhage can occur due to perinatal asphyxia in preterm neonates.^[1]

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, in the floor of the lateral ventricle, 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.^[2] ^{[additional citation(s) needed]}

Diagnosis

Grades

A commonly used classification system of germinal matrix hemorrhage is the sonographic grading system proposed by Papile:^[3]^{[citation needed]}

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.^[4]

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.^[5]

References

^ Enzmann D, Murphy-Irwin K, Stevenson D, Ariagno R, Barton J, Sunshine P (1985). "The natural history of subependymal germinal matrix hemorrhage". Am J Perinatol. 2 (02): 123–33. doi:10.1055/s-2007-999929. PMID 3913430. S2CID 260001720.
^ Papile, Lu-Ann; Burstein, Jerome; Burstein, Rochelle; Koffler, Herbert (April 1978). "Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm". The Journal of Pediatrics. 92 (4): 529–534. doi:10.1016/S0022-3476(78)80282-0. PMID 305471.
^ "The Radiology Assistant : Neonatal Brain US". radiologyassistant.nl. Retrieved 2022-03-22.
^ Leviton, A; Kuban, KC; Pagano, M; Allred, EN; Van Marter, L (June 1993). "Antenatal corticosteroids appear to reduce the risk of postnatal germinal matrix hemorrhage in intubated low birth weight newborns". Pediatrics. 91 (6): 1083–8. doi:10.1542/peds.91.6.1083. PMID 8502506.
^ Romantsik, Olga; Moreira, Alvaro; Thébaud, Bernard; Ådén, Ulrika; Ley, David; Bruschettini, Matteo (2023-02-15). "Stem cell-based interventions for the prevention and treatment of intraventricular haemorrhage and encephalopathy of prematurity in preterm infants". The Cochrane Database of Systematic Reviews. 2 (2): CD013201. doi:10.1002/14651858.CD013201.pub3. ISSN 1469-493X. PMC 9932000. PMID 36790019.