JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
A brain ultrasound revealed echogenic lesions at the caudothalamic grooves, left more prominent than right, highly concerning for a grade 3 germinal matrix hemorrhage in Figure 2A-C (red arrows). A brain magnetic resonance imaging (MRI)
taken 10 days later determined that imaging findings were consistent with a developmental variant in Figure 2D-F (blue arrows). Patient was able to increase enteral feeding, and was weaned off intravenous fluid. She became a good PO feeder and was discharged at 41 weeks old.
Figure 2: Ultrasound of the brain (A), (B) coronal and (C) left sagital planes demonstrate mass-like areas of increased echogenicity in the caudothalamic grooves and within the frontal horns (red arrows), more pronounced on the left, with mild asymmetric dilatation of the left lateral ventricle.
MRI of the brain with T2W images, (D) coronal, (E) axial, and (F) sagittal projections reveal no hemorrhage at the caudothalamic grooves and frontal horns. Imaging findings show enlarged choroid plexi, more prominent on the left (blue arrows). No abnormal MR signal to suggest evolving hemorrhage on T2W sequence. Imaging findings are most consistent with a developmental variant.
25% of infants of gestational age less than 28 weeks will develop a GMH.2 This entity has significant impact on the mortality, morbidity, and long-term neurodevelopment of neonates.³ There are pitfalls and mimics of GMH that must be considered when making a diagnosis. The differential diagnoses in our case presentation included germinal matrix hemorrhage, isolated choroid plexus hemorrhage and ventriculitis, among others. There was no evidence of acute or remote hemorrhagic process as shown by the MRI, eliminating the possibility of a GMH. Isolated choroid plexus hemorrhage would show blood products in the ventricular wall on the MRI, proving an unlikely diagnosis. Ventriculitis would reveal blood products on imaging, also an unlikely diagnosis. Our patient most likely has a developmental variant of the choroid plexus. The apparent echogenic lesions in the frontal horns as seen on ultrasound likely represent prominent choroid plexus. This entity may be easily mistaken as GMH. The lack of well-recognized normal size criteria for choroid plexus makes it difficult to differentiate between normal variants and
DISCUSSION
Germinal matrix hemorrhage (GMH), also known as periventricular hemorrhage or preterm caudothalamic hemorrhage, is a frequent, serious complication of prematurity. It is an intraventricular hemorrhage originating from the subependymal germinal matrix, a highly cellular and vascularized region of neuronal-glial precursor cells in the developing brain.1 This area is especially vulnerable to birth injury and blood pressure changes following birth, which may result in hemorrhage. GMH results in parenchymal damage, intraventricular residues of hemorrhage, and hydrocephalus. 20-
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