The study of choice to diagnose a germinal matrix bleed is a brain ultrasound. On the coronal view, the germinal matrix hemorrhage appears as an area of increased echogenicity just below the frontal horn of the lateral ventricles (Figure 252.1). Germinal matrix bleeds require no treatment.
Figure 252.1.— Germinal matrix hemorrhages (GMH) appear as an area of increased echogenicity just below the frontal horn. L: left; D: days; PVHI: periventricular hemorrhagic infarction; B: bilateral.
The evolution of germinal matrix hemorrhages varies. Ganglionic germinal matrix bleeds may resolve or progress (Figure 252.2) to intraventricular hemorrhages, periventricular infarctions, or parenchymal hemorrhage.
Resolution of ganglionic germinal matrix hemorrhages
Germinal matrix bleeds may resolve, leading to disappearance of the ultrasonographic abnormality in the area of the bleed or the appearance of a cyst in the same area. Most cysts ultimately disappear.
Progression of ganglionic germinal matrix bleed to intraventricular hemorrhage
Intraventricular hemorrhage is probably the most frequent complication of germinal matrix bleeding (Figure 252.2). It occurs when blood from the germinal matrix tears the ependymal layer and spills into the ventricles. Intraventricular hemorrhage may resolve, produce an acute hemorrhagic hydrocephalus, or lead to post-hemorrhagic hydrocephalus.
Figure 252.2.— Progression of germinal matrix hemorrhage.
of intraventricular hemorrhage
Figure 252.3.— Ultrasound studies demonstrating progression of germinal matrix hemorrhage to intraparenchymal hemorrhage and the development of acute hydrocephalus. GMH: germinal matrix hemorrhage; D: days; IPH: intraparenchymal hemorrhage.