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Grade 3 GM-IVH

Grade 3 haemorrhage is characterised by intraventricular haemorrhage occupying at least 50% of the ventricle.  The ventricles may appear distended or dilatation may develop secondary to posthaemorrhagic hydrocephalus.  There may also be parenchymal involvement if there is venous obstruction.

The following images are from a 25 week infant delivered in good condition.  He was not initially ventilated but deteriorated on the second day with pallor, acidosis, hypotension and poor handling.  He was intubated and ventilated.  A full blood count showed a marked reduction in haemoglobin.

Day 2 Scan

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	The initial scan demonstrates a moderate sized germinal matrix haemorrhage on the right.  There appears to be some intraventricular blood.  This would be graded as a right Grade 2 GM-IVH.  The ventricles are a little prominent but not dilated nor distended.

Day 3 Scan

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	The baby continued to deteriorate.  The following day, the fontanelle was tense.  A repeat scan demonstrated an acute intraventricular haemorrhage on the left side.  The left ventricle is grossly distended with blood, with midline shift.  The right lateral ventricle looks dilated.  This may represent obstruction to CSF flow or acute haemorrhage where the blood does not always appear echogenic.  In the second coronal image, blood is seen in the temporal horns of the lateral ventricles. It is difficult to find the midline structures in the sagittal view because of the distortion of anatomy.  There is also blood in the third ventricle (seen as an echogenic focus in the midline).

Day 4 Scan

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The following day, the ultrasound demonstrates bilateral intraventricular haemorrhage with distension of both ventricles (although there is still some midline shift to the right).  The temporal horn of the left lateral ventricle is full of blood in the coronal section. There is also a parenchymal haemorrhage on the left, seen as an echogenic focus on the left. This baby was extremely neurologically abnormal at this point and care was withdrawn in view of the extremely poor neurodevelopmental prognosis.