Intraventricular hemorrhage may occur in neonates, typically those that are premature, usually as a result of hypoxemia. Imaging studies (CT scans, MRI or ultrasound) can be used to grade the extent of the hemorrhage. While the lower grade lesions tend to resolve without residua, the higher grade lesions may be associated with morbidity and mortality.
Extent of Hemorrhage
Grade
hemorrhage in the subependymal germinal matrix
I
hemorrhage of the subependyma with intraventricular hemorrhage, without ventricular dilatation
II
intraventricular hemorrhage with enlargement/dilatation of the lateral ventricle(s)
III
intraventricular hemorrhage with encephalic/parenchymal hemorrhage
IV
Sub-Ependymal Hemorrhage
Intra-Ventricular Hemorrhage
Ventricular Dilatation
Parenchymal Hemorrhage
Grade
absent
absent
absent
absent
0
present
absent
absent
absent
I
present
present
absent
absent
II
present
present
present
absent
III
present
present
present
present
IV
Grade I and II hemorrhages may be asymptomatic and usually respond spontaneously.
The higher grade lesions may present clinically with:
(1) change in muscular tone or activity
(2) seizures
(3) full fontanel
(4) hypotension
A CSF sample will show blood in all tubes collected.
Hydrocephalus may develop in infants with Grade III or IV hemorrhage.
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