Ministry of Health

NZ Government

    
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Posthaemorrhagic Hydrocephalus

Background

Hydrocephalus developing following a significant Germinal Matrix haemorrhage is not uncommon and is related closely to the severity of the initial haemorrhage. 

The aetiology is thought to be due to both the effects of blood clots on CSF absorption acutely and, later, obliterative arachnoiditis.  Impaired CSF flow usually occurs at the outflow of the 4th ventricle as most frequently the hydrocephalus is communicating.

Although clinical signs of hydrocephalus (such as rapid head growth, bulging anterior fontanelle, and separated sutures) occur, these are usually well after imaging has demonstrated significant ventricular dilatation.

Drug therapy to prevent or treat ventricular dilatation has not been shown to be helpful.  The role of serial lumbar punctures has also been disappointing, although there is still a role for this in some infants.  Infants with rapid progressive ventricular dilatation or signs of raised intracranial pressure may require a ventricular reservoir or ventriculoperitoneal shunting.

Week 1 Scan

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	This baby has suffered a significant GM-IVH with haemorrhage seen in the right lateral ventricle particularly.  There is already significant dilatation of the lateral and third ventricles.

Week 2 Scan

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	One week later, there has been progressive dilatation of the lateral ventricles and third ventricle.  The temporal horns of the lateral ventricles are dilated, seen well in both the coronal and sagittal views.

CT Scans Before and After Placement of a Ventricular Reservoir

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	The images to the left show the same baby only a few days after the ultrasound above.
	Following the insertion of a ventricular reservoir (and daily drainage procedures), there is still significant ventricular dilatation.

1.  Volpe JJ.  Neurology of the newborn (4th edition).  WB Saunders Co (Phil).