Germinal matrix hemorrhage is a bleeding into the subependyma

Ependyma

Ependyma is the thin epithelial membrane lining the ventricular system of the brain and the spinal cord. Ependyma is one of the four types of neuroglia in the central nervous system. It is involved in the production of cerebrospinal fluid ....

l germinal matrix

Germinal matrix

In anatomy, the germinal matrix is a highly cellular and highly vascularized region in the brain from which cells migrate out during brain development. The germinal matrix is the source of both neurons and glial cells and is most active between 8 and 28 weeks gestation...

 with or without subsequent rupture into the lateral ventricle.

Pathophysiology

The germinal matrix is the site of proliferation neuronal and glial precursors in the developing brain, which is located above the caudate nucleus

Caudate nucleus

The caudate nucleus is a nucleus located within the basal ganglia of the brains of many animal species. The caudate nucleus is an important part of the brain's learning and memory system.-Anatomy:...

, in the floor of the lateral ventricle, and caudothalamic groove. The germinal matrix contains a rich network of fragile thin-walled blood vessels. Hence the microcirculation in this particular area is extremely sensitive to hypoxia and changes in perfusion pressure. It is most frequent before 35 weeks gestation

Gestation

Gestation is the carrying of an embryo or fetus inside a female viviparous animal. Mammals during pregnancy can have one or more gestations at the same time ....

 and is typically seen in very low birth-weight (<1500g) premature infants

Premature birth

In humans preterm birth refers to the birth of a baby of less than 37 weeks gestational age. The cause for preterm birth is in many situations elusive and unknown; many factors appear to be associated with the development of preterm birth, making the reduction of preterm birth a challenging...

,because they lack the ability for auto regulation of cerebral blood flow. Consequently increased arterial blood pressure in these blood vessels leads to rupture and hemorrhage into germinal matrix.

Clinical Features

This may lead to various neurological sequelae including presentation with cerebral palsy, mental retardation and seizures.

Grades

Four grades are distinguished (by imaging or histology): grade I (hemorrhage is confined to the germinal matrix), grade II (intraventricular hemorrhage without ventricular dilatatation), grade III (intraventricular hemorrhage with ventricular dilatation), and grade IV (intraventricular rupture and hemorrhage into the surrounding white matter).

Treatment

Antenatal corticosteroids have a role in reducing incidence of germinal matrix hemorrhage in premature infants.