Germinal matrix hemorrhage (GMH) most common at caudothalamic (CT) groove in vascular germinal matrix

Grading system

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  Grade 1 : GMH only with globular echogenic focus in CT groove

  
  
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  Grade 2 : GMH + intraventricular hemorrhage (IVH), normal ventricle size

  
  
  
  
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    Look for fluid-debris levels in dependent occipital horns

  
  
  
  
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  Grade 3 : GMH + IVH + ventricular expansion

  
  
  
  
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    Ventricular expansion some days after grade 2 IVH = secondary hydrocephalus

  
  
  
  
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  Grade 4 : GMH + IVH + intraparenchymal hemorrhage

  
  
  
  
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    Venous compression leads to periventricular hemorrhagic venous infarction

    
    
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    Fan-shaped, echogenic, can liquefy, infarcted brain may be replaced by porencephalic cyst

  
  

Hypoxic-ischemic encephalopathy: Ischemic injury due to perinatal insult

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  Abnormal echogenicity of affected deep gray &/or white matter

  
  
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  Heals as periventricular leukomalacia with Swiss cheese pattern in deep white matter

Use small-footprint, high-frequency transducers with multiple focal zones

Use multiple points of access (anterior/posterior fontanel, mastoid, temporal bone)

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  Look for fluid levels, blood in 3rd, 4th ventricles, cerebellar hemorrhage

  
  
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  Any grade of GMH has worse prognosis in setting of coexistent cerebellar hemorrhage

Cine clips, color Doppler help differentiate avascular, variable-echogenicity clot from echogenic choroid