Grade IV Intracranial Hemorrhage

in a Premature Neonate
Madison Bohon
DMS 496
Summer 2015

CASE HISTORY
Follow-up exam.
Previous done on 5/10/15.
Relevant lab value is hematocrit.
Patient born at 23 weeks, weighing
520 grams.

SONOGRAPHIC APPEARANCE

FIGURE ONE: COMPARISON OF RT AND LT LATERAL VENTRICLES.

SONOGRAPHIC APPEARANCE

FIGURE TWO: COMPARISON OF PARENCHYMAL ECHOGENICITY

SONOGRAPHIC APPEARANCE

FIGURE THREE: DEMONSTRATION OF PARENCHYMAL BLEED

SONOGRAPHIC APPEARANCE

FIGURE FOUR: CENTRALIZED CYSTIC AREA WITH CLOT

SONOGRPAHIC APPEARANCE

FIGURE FIVE: INTRAPARENCHYMAL HEMORRHAGE

SONOGRAPHIC APPEARANCE

FIGURE SIX AND SEVEN: COMPARISON

OF RT AND LT VENTRICLES

SONOGRAPHIC APPEARANCE

FIGURE EIGHT: HEMORRHAGIC RESOLUTION

DIAGNOSIS
Evolving RT sided grade IV
hemorrhage with unchanged
ventriculomegaly.

DIAGNOSIS
Definition: Presence of dilated, blood-

filled ventricles with concurrent

intraparenchymal hemorrhage.
Anoxic events cause vasodilation, which

results in ruptured, immature, thinwalled germinal matrix blood vessels.

FOLLOW-UP
Three more neurosonograms were
performed.
Less residual clot, and no
ventriculomegaly.
Cystic area consistent with
porencephaly related to grade IV IVH.

CONCLUSION
Premature baby born at 23 weeks head US
found grade IV IVH. Follow-ups ordered.
ICH is a major source of neonate morbidity
and mortality especially in preterm infants.
Bleeds generally occur during the second or
third post natal day, so if the US is ordered
too soon a hemorrhage might be missed.

REFERENCES
1. American Academy of Pediatric Dentistry.
http://www.aapd.org/media/Policies_Guidelines/RS_LabValues.
pdf
. Accessed July 8 2015.
2. Baun J. Neonatal Intracranial Hemorrhage. JDMS June 2009 ;
7:120-131.
3. Fox T. Sonography of the Neonatal Brain. JDMS
November/December 2009; 25:331-348.
4. Rumack C, Wilson S, Charboneau J, Levine D: Diagnostic
Ultrasound. 4Th ed. Vol. 2. Philadelphia, PA, Elseviar Saunders
2011.
5. Rumack C, Wilson S, Charboneau J, Levine D: Diagnostic
Ultrasound. 4TH ed. Vol. 2. Philadelphia, PA, Elsevier Saunders
2011.