Cerebral intraventricular hemorrhage: pathophysiology and clinical outcomes

Cerebral Intraventricular Hemorrhage (IVH) can involve many infants. It is widely recognized in infants that are premature and has also been seen in infants that are two weeks to three months old, as well as extremely young babies that are just born. This indicates that the age spectrum in which this problem occurs is widening to some degree. Quite often, IVH is misdiagnosed as being meningitis with a traumatic lumbar tap or a subarachnoid hemorrhage, which are treated differently. Primarily, IVH occurs in infants that have ischemia, hypoxemia, acidosis, and/or hypernatremia, which are some conditions that are usually found in relation to IVH in premature infants. However, IVH can also be a spontaneous occurrence in any infant that is premature. Diagnostic procedures for determining the problem are very important, and the most significant and widely used one for the diagnosis of IVH is computerized tomography (pediatrics.aappublications.org, 1980).

In preterm neonates, IVH and germinal matrix hemorrhage (GMH) are some of the most important and neurological injuries. In the brain of the infant that is premature, there is a lack of ability to regulate the cerebral blood pressure. Normally, this pressure is regulated by the body automatically, but the premature infant is not able to do this for itself. Because of this, there are fluctuations in the pressure and the flow of cerebral blood which can lead to ruptures and hemorrhages. Naturally, these hemorrhages are to be avoided and can cause significant neurological problems such as cerebral palsy, seizures, and various forms of mental retardation, which cannot be corrected. There are also significantly high numbers for mortality when it comes to IVH (www.emedicine.com).

A discussion of IVH often includes information about GMH, and the two are often linked together or treated as one and the same. Characterizing the neuropathology of IVH is a common lesion. From that lesion, there is bleeding into the subependymal germinal matrix. Sometimes there is a subsequent rupture, usually into the lateral ventricle, but this is not required for a diagnosis of IVH. There is a multifactorial pathogenesis that is associated with IVH. These can include three different factors: extravascular, vascular, and intravascular. In infants that are premature, the regulation of blood flow and pressure is very primitive. Because the germinal matrix is so very primitive and thin, there is a much higher chance that it could rupture. How primitive the glial and mesenchymal tissues are have a great deal to do with the extent of the hemorrhage (www.emedicine.com).