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]
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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]
Diagnosis
Grades
Four grades are distinguished (by imaging or histology):
- 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
Prevention
Antenatal corticosteroids have a role in reducing incidence of germinal matrix hemorrhage in premature infants.[3]
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.[4]
See also
- Ganglionic eminence, a part of the germinal matrix
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 (2): 123–33. doi:10.1055/s-2007-999929. PMID 3913430.
- 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.
- 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. PMID 8502506.
- Romantsik, O; Bruschettini, M; Moreira, A; Thébaud, B; Ley, D (24 September 2019). "Stem cell-based interventions for the prevention and treatment of germinal matrix-intraventricular haemorrhage in preterm infants". The Cochrane database of systematic reviews. 9: CD013201. doi:10.1002/14651858.CD013201.pub2. PMID 31549743.