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TAS Neonatal Medicine ✅ > Periventricular-Intraventricular Haemorrhage ✅ > Flashcards

Periventricular-Intraventricular Haemorrhage ✅ Flashcards

1
Q

What is the most common neurological complication of preterm infants?

A

Periventricular-intraventricular (PVH-IVH)

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2
Q

How does gestational age affect the incidence of PVH-IVH?

A

Inversely related

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3
Q

What can PVH-IVH lead to?

A

Neurodevelopmental impairment and death

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4
Q

What causes PVH-IVH?

A

Rupture of the fragile capillary network in the subependymal (also called germinal) matrix of the developing brain

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5
Q

Where is the subependymal matrix of the brain found?

A

Overlies the head of the caudate nucleus

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6
Q

What is it called when the haemorrhage is confined to the subependymal region in PVH-IVH?

A

Germinal matrix haemorrhage (GMH)

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7
Q

Where might the haemorrhage also involve in PVH-IVH?

A
  • Body of the lateral ventricles

- Cerebral cortical parenchyma

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8
Q

What is it called when a PVH-IVH haemorrhage extends into the body of the lateral ventricles?

A

Intraventricular haemorrhage

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9
Q

What is it called when a PVH-IVH involves the cerebral cortical parenchyma?

A

Parenchymal haemorrhage

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10
Q

Is involvement of the cerebral cortical parenchyma an extension of the haemorrhage in PVH-IVH?

A

No

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11
Q

What causes cerebral cortical parenchymal involvement in PVH-IVH?

A

Venous infarct related to obstruction to the venous drainage of the white matter

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12
Q

What happens following venous infarct of the cerebral cortical parenchyma in PVH-IVH?

A

It undergoes cystic degeneration

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13
Q

What has developed by term when there is cerebral cortical parenchyma involvement in PVH-IVH?

A

A porencephalic cyst

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14
Q

What are intraventricular haemorrhages classified into?

A

Grade (1-4)

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15
Q

What lesions may be found on cranial ultrasound?

A
  • Haemorrhage
  • Cystic periventricular leukomalacia (PVL)
  • Periventricular white matter echo density (PVE)
  • Post-haemorrhagic ventricular dilation/hydrocephalus
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16
Q

What is the grade of a intraventricular haemorrhage determined by?

A

Ultrasound appearances

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17
Q

What is a grade I haemorrhage?

A

Isolated germinal matrix haemorrhage

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18
Q

What is a grade 2 haemorrhage?

A

Intraventricular haemorrhage (GMH-IVH) - <50% of ventricular area on parasagittal view

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19
Q

What is a grade 3 haemorrhage?

A

GMH-IVH with dilatation - >50% of ventricular area on parasagittal view, usually distends lateral ventricle

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20
Q

What is a grade 4 haemorrhage?

A

Haemorrhage parenchymal infarct (parenchyma lesion)

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21
Q

What may a grade 4 haemorrhage evolve into?

A

A porencephalic cyst

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22
Q

What might a periventricular white matter echodensity evolve into?

A

Periventricular or deep white matter cysts

23
Q

What is the use of serial cranial ultrasound in PVH-IVH?

A

Detect intraventricular haemorrhage, porencephalic cysts, and ventricular dilatation or hydrocephalus

24
Q

Why might hydrocephalus be found on serial cranial ultrasound in PVH-IVH?

A

It is a complication of intraventricular haemorrhage

25
Q

What is the concordance between cranial USS diagnosis and autopsy diagnosis?

A

> 90%

26
Q

What are the key factors in the pathogenesis of PVH-IVH?

A
  • Immature germinal matrix capillary network
  • Impaired cerebral autoregulation
  • Abnormal coagulation
27
Q

What is meant by impaired cerebral autoregualtion as a risk factor for IVH-PVH?

A

Failure to maintain cerebral blood flow within normal limits in spite of wide fluctuations in blood pressure

28
Q

What are the prenatal risk factors for PVH-IVH and PVL?

A
  • IUGR
  • Hypoxia-ischaemia
  • Chorioamnionitis
  • Twin-to-twin transfusion
29
Q

What are the postnatal risk factors for PVH-IVH?

A
  • Preterm
  • Respiratory distress syndrome
  • Cardiovascular instability
  • Pneumothorax
  • Rapid volume expansion
30
Q

What is considered to be ‘uncomplicated IVH’?

A

Grades 1 and 2

31
Q

What can uncomplicated IVH cause long-term?

A

Motor and cognitive impairment

32
Q

What is the risk of developing cerebral palsy in uncomplicated IVH?

A

9%

33
Q

What % of infants with grade III haemorrhage will develop cerebral palsy by 2 years of age?

A

25%

34
Q

What % of infants with grade V haemorrhage will develop cerebral palsy by 2 years of age?

A

50%

35
Q

What is periventricular leukomalacia (PVL)?

A

A periventricular white matter injury

36
Q

What does PVL usually result from?

A

A combination of ischaemia and inflammation

37
Q

What causes the ischaemia causing PVL?

A

Hypoperfusion of the periventricular white matter

38
Q

How does inflammation result in PVL?

A

Causes oligodendroglial injury and failure of myelination

39
Q

What are the prenatal risk factors for PVL?

A
  • Hypoxia-ischaemia
  • Chorioamnionitis
  • Twin-twin transfusion
40
Q

What are the postnatal risk factors for PVL?

A
  • Prematurity
  • Hypocarbia and alkalosis
  • Cardiovascular instability/collapse
  • Necrotising enterocolitis
  • Postnatal corticosteroid treatment
41
Q

What is seen in cystic PVL?

A

There are focal macroscopic areas of necrosis in the periventricular white matter

42
Q

What do the focal areas of necrosis in the periventricular white matter lead to in cystic PVL?

A

Small bilateral periventricular cysts

43
Q

When will periventricular cysts be visible on cranial USS in cystic PVL?

A

From 2 weeks after birth

44
Q

What is the incidence of cystic PVL in VLBW infants?

A

3%

45
Q

What is the clinical significance of cystic PVL?

A

It has a significant impact on neurodevelopment outcome

46
Q

What neurodevelopmental sequence have a high incidence in cystic PVL?

A
  • Diplegic CP
  • Poor visuospatial skills
  • Low IQ scores
47
Q

Is PVL always cystic?

A

No

48
Q

Is cystic or non-cystic PVL more common?

A

Non-cystic

49
Q

What is the difference between cystic and non-cystic PVL?

A

In non-cystic PVL, focal lesions are microscopic in size

50
Q

What happens to the microscopic lesions in non-cystic PVL?

A

They evolve into small glial scars

51
Q

Can glial scars from non-cystic PVL be detected on ultrasound?

A

Not usually

52
Q

How can glial scars from non-cystic PVL be detected?

A

MRI

53
Q

What is the clinical significance of non-cystic PVL?

A

May be responsible for some of the characteristic cognitive difficulties many extremely preterm babies have at school age, rather than cerebral palsy

TAS Neonatal Medicine ✅ (35 decks)

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