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A.Aetiology and
pathogenesis
A.Aetiology and pathogenesis
GMH/IVH :-
GMH/IVH :-
A.Aetiology and
pathogenesis
GMH/IVH :-
A.Aetiology and
pathogenesis
A.Aetiology and
pathogenesis
b-External factors such as mode of delivery or neonatal
GMH/IVH :-
related
to
extravascular factors
intra-vascular,
vascular,
and
GMH/IVH :-
A.Aetiology and
pathogenesis
Ischemia/reperfusion (e.g., volume infusion after hypotension)
Fluctuating CBF (e.g., with mechanical ventilation)
Intravascular factors
Vascular factors
Extra vascular factors
GMH/IVH :-
A.Aetiology and
pathogenesis
A-Intravascular factors
1- Ischemia/reperfusion:- this scenario often occurs shortly
after birth, when a premature infant may have hypovolemia
or hypotension that is treated with infusion of colloid, normal
saline, or hyperosmolar solutions such as sodium bicarbonate.
Rapid infusions of such solutions are thought to be
particularly likely to contribute to GMH/IVH.
2- Fluctuating CBF:-The large fluctuations typically occurred
in infants breathing out of synchrony with the ventilator, but
such fluctuations have also been observed in infants with
large patent ductus arteriosus or hypotension
A.Aetiology and
A-Intravascular factors pathogenesis
3- Increase in CBF:- Sustained increases in CBF may
contribute to GMH/IVH and can be caused by seizures,
hypercarbia, anemia, and hypoglycemia, which result in a
compensatory increase in CBF.
4-Increase in cerebral venous pressure|:- intrathoracic pressure
GMH/IVH :-
GMH/IVH :-
A-Intravascular factors
A.Aetiology and
pathogenesis
GMH/IVH :-
B-Vascular factors
A.Aetiology and
pathogenesis
GMH/IVH :-
A.Aetiology and
pathogenesis
GMH/IVH :-
B-Complications of GMH/IVH.
B-Complications of GMH/IVH.
The two major complications of GMH/IVH are:1-Periventricular hemorrhagic infarction (PVHI)
2-Posthemorrhagic ventricular dilation (PVD).
***********
1-Periventricular hemorrhagic infarction (PVHI)
PVHI has previously been considered an extension of a large IVH
Recently,it is not accepted as an extension of the original IVH, but
is a separate lesion consisting of a venous hemorrhagic infarction.
GMH/IVH :-
B-Complications of GMH/IVH.
b-PVHI occurs on the side of the larger IVH, and Doppler US studies
show markedly decreased or absent flow in the terminal vein on the
side of the large IVH .
c-The ependymal lining of the lateral ventricle separating IVH and
PVHI has been observed to remain intact in some cases, demonstrating
that the IVH did not ""extend" into the adjacent cerebral parenchyma.
GMH/IVH :-
B-Complications of GMH/IVH.
2-Posthemorrhagic
ventricular
dilation
(PVD).or
posthemorrhagic hydrocephalus (PHH-terminology varies),
GMH/IVH :-
B-Complications of GMH/IVH.
GMH/IVH :-
C. Clinical Presentation
C. Clinical Presentation
1-GMH/IVH in the preterm newborn is usually a clinically
Silent syndrome and thus is recognized only when a
routine CUS is performed. The vast majority of these
hemorrhages occur within 72 hours after birth
Infants with large IVH may present with
decreased levels of consciousness and
spontaneous movements, hypotonia,
abnormal eye movements. Rarely, coma,
severe hypotonia and lack of spontaneous
movements, OR generalized tonic posturing
that is often thought to be seizure, but does
not have an electrographic correlate by
electroencephalogram.
GMH/IVH :-
C. Clinical Presentation
Grading of GMH/IVH
GMH/IVH :-
Grading of GMH/IVH
Grading system
Severity of GMH/1VH
Papile
II
III
IV
Description of findings
GMH/IVH :-
GMH/IVH :-
GMH/IVH :-
GMH/IVH :-
GMH/IVH :-
GMH/IVH :-
INTRAPARENCHYMAL HEMORRHAGE
INTRAPARENCHYMAL HEMORRHAGE
INTRAPARENCHYMAL HEMORRHAGE
Clinical presentation
INTRAPARENCHYMAL HEMORRHAGE
Management
Management
1.Small
hemorrhages
require
only
symptomatic treatment and support.
2.Large IPH with severe neurologic
compromise should prompt neurosurgical
intervention. It is important to diagnose
and treat any coexisting pathology, such as
infection or sinus venous thrombosis
INTRAPARENCHYMAL HEMORRHAGE
Prognosis
SUBDURAL HEMORRHAGE
SUBDURAL HEMORRHAGE
Clinical presentation
B. Clinical presentation.
1-When the accumulation of blood is rapid and large, as
occurs with rupture of large veins or sinuses, the
presentation follows shortly after birth as infratentorial
SDH, where compression of the brain stem may result in
nuchal rigidity or opisthotonus, obtundation or coma,
apnea, other abnormal respiratory patterns, and unreactive
pupils .With increased intracranial pressure (ICP), there
may be a bulging fontanelle arid/or widely split sutures.
SUBDURAL HEMORRHAGE
Clinical presentation
Managemen
SUBDURAL HEMORRHAGE
surgical
intervention
and
can
be
when
other
ICH
or
parenchymal
SUBARACHNOID HEMORRHAGE
SUBARACHNOID HEMORRHAGE
SUBARACHNOID HEMORRHAGE
SUBARACHNOID HEMORRHAGE
Clinical presentatio
SUBARACHNOID HEMORRHAGE