Posthemorrhagic Hydrocephalus

1989 ◽  
Vol 4 (1_suppl) ◽  
pp. S23-S31 ◽  
Author(s):  
Philip J. Holt
Keyword(s):  
Intraventricular Hemorrhage ◽  
Treatment Options ◽  
Cranial Ultrasound ◽  
Ventricular Size ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
Ultrasound Studies ◽  
Grading Systems ◽  
Mantle Thickness ◽  
Parenchymal Damage

Post hemorrhagic hydrocephalus (PHH) can be defined as progressive dilation of the ventricular system that develops as a complication of neonatal intraventricular hemorrhage (IVH). Grading systems exist to quantify IVH but not this secondary ventricular dilation. Cranial ultrasound techniques and measuring methods that allow a uniform, objective grading convention for ventricular enlargement are presented. A biventricular to biparietal ratio (BV:BD) can be measured in the coronal images. A ventricular diameter (VD) can be measured in the sagittal images. Cortical mantle thickness and ventricular size can be measured in the axial images. These measurements allow more precise identification of changes in ventricular size which may have treatment implications. The clinical features of PHH and treatment options are also reviewed. No one treatment modality has proven superior, and neurologic outcome does not correlate with development or resolution of PHH. Better description of parenchymal damage is needed during routine ultrasound studies and development of other modalities to assess parenchymal function need to be developed before the significance of IVH and PHH can be fully understood. (J Child Neurol 1989;4:S23-S31).

Ventricular Dilation Following Periventricular-Intraventricular Hemorrhage: Outcome at Age 1 Year

PEDIATRICS ◽  
1984 ◽  
Vol 73 (2) ◽  
pp. 158-162
Author(s):  
Walter C. Allan ◽  
Douglas A. Dransfield ◽  
Alison M. Tito
Keyword(s):  
Intraventricular Hemorrhage ◽  
Neonatal Period ◽  
Neurodevelopmental Outcome ◽  
Expectant Management ◽  
Ventricular Size ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
Neurodevelopmental Delay ◽  
Ventriculoperitoneal Shunting ◽  
Neurodevelopmental Abnormalities

Ventricular dilation following periventricular-intraventricular hemorrhage can be managed without ventriculoperitoneal shunting in most cases. Twenty-six patients who had periventricular-intraventricular hemorrhage with subsequent ventricular dilation were examined at 1 year of age for neurodevelopmental outcome and hydrocephalus. As previously reported, ventricular dilation may be divided into two groups: ventriculomegaly and posthemorrhagic hydrocephalus. Fourteen patients with ventriculomegaly were followed up with serial ultrasound observations only, and 12 patients with posthemorrhagic hydrocephalus had temporary drainage of ventricular fluid. Only three patients with posthemorrhagic hydrocephalus required ventriculoperitoneal shunting in the neonatal period. Neurodevelopmental abnormalities were found in eight infants who had posthemorrhagic hydrocephalus and two who had ventriculomegaly. Six of these infants had intraparenchymal injury demonstrated by ultrasound, five as a result of the original hemorrhage and 1 by infection. A single infant with posthemorrhagic hydrocephalus, discharged from the hospital with stable ventricular size, developed hydrocephalus and neurodevelopmental delay after the neonatal period. This reversed with ventriculopenitoneal shunting at 1 year of age. It is suggested that even in patients developing ventricular dilation following periventricular-intraventricular hemorrhage, it is the primary intraparenchymal injury that is responsible for subsequent morbidity. Thus, provided serial reevaluations are possible, an expectant management of ventricular dilation is justified.

scholarly journals Resolution of neonatal posthemorrhagic ventricular dilation coincident with patent ductus arteriosus ligation: case report

2020 ◽  
Vol 26 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Erik B. Vanstrum ◽  
Matthew T. Borzage ◽  
Jason K. Chu ◽  
Shuo Wang ◽  
Nolan Rea ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Intraventricular Hemorrhage ◽  
Ductus Arteriosus ◽  
Medical Intervention ◽  
Cranial Ultrasound ◽  
Ventricular Dilation ◽  
Venous Flow ◽  
Systemic Hemodynamic ◽  
Patent Ductus

Preterm infants commonly present with a hemodynamically significant patent ductus arteriosus (hsPDA). The authors describe the case of a preterm infant with posthemorrhagic ventricular dilation, which resolved in a temporally coincident fashion to repair of hsPDA. The presence of a PDA with left-to-right shunting was confirmed at birth on echocardiogram and was unresponsive to repeated medical intervention. Initial cranial ultrasound revealed periventricular-intraventricular hemorrhage. Follow-up serial ultrasound showed resolving intraventricular hemorrhage and progressive bilateral hydrocephalus. At 5 weeks, the ductus was ligated with the goal of improving hemodynamic stability prior to CSF diversion. However, neurosurgical intervention was not required due to improvement of ventriculomegaly occurring immediately after PDA ligation. No further ventricular dilation was observed at the 6-month follow-up.Systemic venous flow disruption and abnormal patterns of cerebral blood circulation have been previously associated with hsPDA. Systemic hemodynamic change has been reported to follow hsPDA ligation, although association with ventricular normalization has not. This case suggests that the unstable hemodynamic environment due to left-to-right shunting may also impede CSF outflow and contribute to ventriculomegaly. The authors review the literature surrounding pressure transmission between a PDA and the cerebral vessels and present a mechanism by which PDA may contribute to posthemorrhagic ventricular dilation.

scholarly journals Does ventricle size contribute to cognitive outcomes in posthemorrhagic hydrocephalus? Role of early definitive intervention

2021 ◽  
pp. 1-11
Author(s):  
Mounica Paturu ◽  
Regina L. Triplett ◽  
Siddhant Thukral ◽  
Dimitrios Alexopoulos ◽  
Christopher D. Smyser ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Brain Mri ◽  
Neurodevelopmental Outcome ◽  
Optimal Time ◽  
Preterm Neonates ◽  
Third Ventriculostomy ◽  
Cranial Ultrasound ◽  
Ventricular Size ◽  
Posthemorrhagic Hydrocephalus ◽  
Ventricle Size

OBJECTIVE Posthemorrhagic hydrocephalus (PHH) is associated with significant morbidity, smaller hippocampal volumes, and impaired neurodevelopment in preterm infants. The timing of temporary CSF (tCSF) diversion has been studied; however, the optimal time for permanent CSF (pCSF) diversion is unknown. The objective of this study was to determine whether cumulative ventricle size or timing of pCSF diversion is associated with neurodevelopmental outcome and hippocampal size in preterm infants with PHH. METHODS Twenty-five very preterm neonates (born at ≤ 32 weeks’ gestational age) with high-grade intraventricular hemorrhage (IVH), subsequent PHH, and pCSF diversion with a ventriculoperitoneal shunt (n = 20) or endoscopic third ventriculostomy (n = 5) were followed until 2 years of age. Infants underwent serial cranial ultrasounds from birth until 1 year after pCSF diversion, brain MRI at term-equivalent age, and assessment based on the Bayley Scales of Infant and Toddler Development, Third Edition, at 2 years of age. Frontooccipital horn ratio (FOHR) measurements were derived from cranial ultrasounds and term-equivalent brain MRI. Hippocampal volumes were segmented and calculated from term-equivalent brain MRI. Cumulative ventricle size until the time of pCSF diversion was estimated using FOHR measurements from each cranial ultrasound performed prior to permanent intervention. RESULTS The average gestational ages at tCSF and pCSF diversion were 28.9 and 39.0 weeks, respectively. An earlier chronological age at the time of pCSF diversion was associated with larger right hippocampal volumes on term-equivalent MRI (Pearson’s r = −0.403, p = 0.046) and improved cognitive (r = −0.554, p = 0.047), motor (r = −0.487, p = 0.048), and language (r = −0.414, p = 0.021) outcomes at 2 years of age. Additionally, a smaller cumulative ventricle size from birth to pCSF diversion was associated with larger right hippocampal volumes (r = −0.483, p = 0.014) and improved cognitive (r = −0.711, p = 0.001), motor (r = −0.675, p = 0.003), and language (r = −0.618, p = 0.011) outcomes. There was no relationship between time to tCSF diversion or cumulative ventricle size prior to tCSF diversion and neurodevelopmental outcome or hippocampal size. Finally, a smaller cumulative ventricular size prior to either tCSF diversion or pCSF diversion was associated with a smaller ventricular size 1 year after pCSF diversion (r = 0.422, p = 0.040, R2 = 0.178 and r = 0.519, p = 0.009, R2 = 0.269, respectively). CONCLUSIONS In infants with PHH, a smaller cumulative ventricular size and shorter time to pCSF diversion were associated with larger right hippocampal volumes, improved neurocognitive outcomes, and reduced long-term ventriculomegaly. Future prospective randomized studies are needed to confirm these findings.

scholarly journals Intraventricular Hemorrhage Clearance in Human Neonatal Cerebrospinal Fluid

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1712-1719 ◽  
Author(s):  
Kelly B. Mahaney ◽  
Chandana Buddhala ◽  
Mounica Paturu ◽  
Diego Morales ◽  
David D. Limbrick ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Lumbar Puncture ◽  
Intraventricular Hemorrhage ◽  
Total Bilirubin ◽  
Preterm Neonates ◽  
Low Grade ◽  
Cranial Ultrasound ◽  
High Grade ◽  
Posthemorrhagic Hydrocephalus ◽  
Fluid Blood

Background and Purpose— Preterm neonates with intraventricular hemorrhage (IVH) are at risk for posthemorrhagic hydrocephalus and poor neurological outcomes. Iron has been implicated in ventriculomegaly, hippocampal injury, and poor outcomes following IVH. We hypothesized that levels of cerebrospinal fluid blood breakdown products and endogenous iron clearance proteins in neonates with IVH differ from those of neonates with IVH who subsequently develop posthemorrhagic hydrocephalus. Methods— Premature neonates with an estimated gestational age at birth <30 weeks who underwent lumbar puncture for clinical evaluation an average of 2 weeks after birth were evaluated. Groups consisted of controls (n=16), low-grade IVH (grades I–II; n=4), high-grade IVH (grades III–IV; n=6), and posthemorrhagic hydrocephalus (n=9). Control subjects were preterm neonates born at <30 weeks’ gestation without brain abnormality or hemorrhage on cranial ultrasound, who underwent lumbar puncture for clinical purposes. Cerebrospinal fluid hemoglobin, total bilirubin, total iron, ferritin, ceruloplasmin, transferrin, haptoglobin, and hemopexin were quantified. Results— Cerebrospinal fluid hemoglobin levels were increased in posthemorrhagic hydrocephalus compared with high-grade IVH (9.45 versus 6.06 µg/mL, P <0.05) and cerebrospinal fluid ferritin levels were increased in posthemorrhagic hydrocephalus compared with controls (511.33 versus 67.08, P <0.01). No significant group differences existed for the other cerebrospinal fluid blood breakdown and iron-handling proteins tested. We observed positive correlations between ventricular enlargement (frontal occipital horn ratio) and ferritin (Pearson r =0.67), hemoglobin (Pearson r =0.68), and total bilirubin (Pearson r =0.69). Conclusions— Neonates with posthemorrhagic hydrocephalus had significantly higher levels of hemoglobin than those with high-grade IVH. Levels of blood breakdown products, hemoglobin, ferritin, and bilirubin correlated with ventricular size. There was no elevation of several iron-scavenging proteins in cerebrospinal fluid in neonates with posthemorrhagic hydrocpehalus, indicative of posthemorrhagic hydrocephalus as a disease state occurring when endogenous iron clearance mechanisms are overwhelmed.

A Potential Mechanism of Pathogenesis for Early Posthemorrhagic Hydrocephalus in the Premature Newborn

PEDIATRICS ◽  
1984 ◽  
Vol 73 (1) ◽  
pp. 19-21
Author(s):  
Alan Hill ◽  
Gary D. Shackelford ◽  
Joseph J. Volpe
Keyword(s):  
Particulate Matter ◽  
Posterior Fossa ◽  
Intraventricular Hemorrhage ◽  
Ventricular System ◽  
Potential Mechanism ◽  
Ultrasound Scanning ◽  
Csf Flow ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
Expected Time

Ventricular dilation is common following intraventricular hemorrhage. Neuropathologic studies have demonstrated that chronic posthemorrhagic hydrocephalus most commonly is a result of an obliterative arachnoiditis in the posterior fossa or is due to obstruction of flow of CSF within the ventricular system. Recent use of ultrasound scanning has demonstrated the occurrence of ventricular dilation within days of intraventricular hemorrhage (prior to the expected time of development of arachnoiditis). In the case described, serial realtime ultrasound scans demonstrated small mobile particles within dilated ventricles seven days following intraventicular hemorrhage. There was no obstruction of CSF flow within the ventricular system. Thus, in this case, ventricular dilation may have been secondary to plugging of arachnoid villi by the small particulate matter and, as a consequence, decrease in CSF reabsorption.

scholarly journals Center effect and other factors influencing temporization and shunting of cerebrospinal fluid in preterm infants with intraventricular hemorrhage

2012 ◽  
Vol 9 (5) ◽  
pp. 473-481 ◽  
Author(s):  
Jay Riva-Cambrin ◽  
Chevis N. Shannon ◽  
Richard Holubkov ◽  
William E. Whitehead ◽  
Abhaya V. Kulkarni ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Practice Patterns ◽  
Clinical Findings ◽  
Research Network ◽  
Ventricular Size ◽  
Posthemorrhagic Hydrocephalus ◽  
Center Effect ◽  
Csf Diversion ◽  
Ventricular Reservoir

Object There is little consensus regarding the indications for surgical CSF diversion (either with implanted temporizing devices [reservoir or subgaleal shunt] or shunt alone) in preterm infants with posthemorrhagic hydrocephalus. The authors determined clinical and neuroimaging factors associated with the use of surgical CSF diversion among neonates with intraventricular hemorrhage (IVH), and describe variations in practice patterns across 4 large pediatric centers. Methods The use of implanted temporizing devices and conversion to permanent shunts was examined in a consecutive sample of 110 neonates surgically treated for IVH related to prematurity from the 4 clinical centers of the Hydrocephalus Clinical Research Network (HCRN). Clinical, neuroimaging, and so-called processes of care factors were analyzed. Results Seventy-three (66%) of the patients underwent temporization procedures, including 50 ventricular reservoir and 23 subgaleal shunt placements. Center (p < 0.001), increasing ventricular size (p = 0.04), and bradycardia (p = 0.07) were associated with the use of an implanted temporizing device, whereas apnea, occipitofrontal circumference (OFC), and fontanel assessments were not. Implanted temporizing devices were converted to permanent shunts in 65 (89%) of the 73 neonates. Only a full fontanel (p < 0.001) and increased ventricular size (p = 0.002) were associated with conversion of the temporizing devices to permanent shunts, whereas center, OFCs, and clot characteristics were not. Conclusions Considerable center variability exists in neurosurgical approaches to temporization of IVH in prematurity within the HCRN; however, variation between centers is not seen with permanent shunting. Increasing ventricular size—rather than classic clinical findings such as increasing OFCs—represents the threshold for either temporization or shunting of CSF.

Serial Cranial Ultrasound Studies in Preterm Infants

2020 ◽  
Vol 103 (9) ◽  
pp. 926-930
Keyword(s):  
Preterm Infants ◽  
Medical Records ◽  
Intraventricular Hemorrhage ◽  
Neonatal Intensive Care ◽  
Cranial Ultrasound ◽  
Discrimination Analysis ◽  
Ultrasound Studies ◽  
Ultrasound Findings ◽  
Infant Screening ◽  
A Prospective Study

Objective: To study reasonable timing for repeating head ultrasound screenings (HUS) in preterm infants and to find out any change in severity of intraventricular hemorrhage. Materials and Methods: Medical records and ultrasound findings of all preterm infants younger than 32 weeks gestational age (GA) admitted to the neonatal intensive care unit (NICU) at Phramongkutklao Hospital between January 1, 2014 and December 31, 2018 were reviewed retrospectively. Results: One hundred thirty-three infants were included in the present study. Eighty-five infants had at least two HUS and included in discrimination analysis. The positive predictive value for having a normal HUS after two previously normal studies seven or more days apart was 89.30% with a specificity of 80%. Of the 24 preterm infants with IVH, 19 had repeated the cranial ultrasound. This revealed that repeating HUS early (day 7 or earlier), 90% (9/10 infants) found no change in finding, whereas repeating HUS at day 30 or later revealed as high as 76.4% change in findings. Conclusion: Routine screening of cranial ultrasound examinations are recommended for all infants born before 32 weeks GA. If the scan is abnormal, repeating the scan at day 30 or later may be more helpful than as early as day 7. However, if the scan showed no abnormality and had been repeated seven or fewer days apart with the same negative result, subsequent scan may not add benefits. However, these findings need to be proved and may be used only as a guide to design a prospective study in the future. Keywords: Preterm infant, Screening cranial ultrasound, Intraventricular hemorrhage

scholarly journals Anatomical configurations associated with posthemorrhagic hydrocephalus among premature infants with intraventricular hemorrhage

2016 ◽  
Vol 41 (5) ◽  
pp. E5 ◽  
Author(s):  
Hannah M. Tully ◽  
Tara L. Wenger ◽  
Walter A. Kukull ◽  
Dan Doherty ◽  
William B. Dobyns
Keyword(s):  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Surgical Planning ◽  
Surgical Intervention ◽  
Brain Mri ◽  
Mr Images ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
The Mean ◽  
Grade Iii

OBJECTIVE Intraventricular hemorrhage (IVH) is a complication of prematurity often associated with ventricular dilation, which may resolve over time or progress to posthemorrhagic hydrocephalus (PHH). This study investigated anatomical factors that could predispose infants with IVH to PHH. METHODS The authors analyzed a cohort of premature infants diagnosed with Grade III or IV IVH between 2004 and 2014. Using existing ultrasound and MR images, the CSF obstruction pattern, skull shape, and brain/skull ratios were determined, comparing children with PHH to those with resolved ventricular dilation (RVD), and comparing both groups to a set of healthy controls. RESULTS Among 110 premature infants with Grade III or IV IVH, 65 (59%) developed PHH. Infants with PHH had more severe ventricular dilation compared with those with RVD, although ranges overlapped. Intraventricular CSF obstruction was observed in 36 (86%) of 42 infants with PHH and 0 (0%) of 18 with RVD (p < 0.001). The distribution of skull shapes in infants with PHH was similar to those with RVD, although markedly different from controls. No significant differences in supratentorial brain/skull ratio were observed; however, the mean infratentorial brain/skull ratio of infants with PHH was 5% greater (more crowded) than controls (p = 0.006), whereas the mean infratentorial brain/skull ratio of infants with RVD was 8% smaller (less crowded) than controls (p = 0.004). CONCLUSIONS Among premature infants with IVH, intraventricular obstruction and infratentorial crowding are strongly associated with PHH, further underscoring the need for brain MRI in surgical planning. Prospective studies are required to determine which factors are cause and which are consequence, and which can be used to predict the need for surgical intervention.

scholarly journals Ventricular Dilation Following Intraventricular Hemorrhage in the Premature Infant

1983 ◽  
Vol 10 (2) ◽  
pp. 81-85 ◽  
Author(s):  
Alan Hill
Keyword(s):  
Cerebrospinal Fluid ◽  
Intraventricular Hemorrhage ◽  
Clinical Signs ◽  
Normal Pressure ◽  
Ventricular Drainage ◽  
Ventricular Size ◽  
Anterior Fontanelle ◽  
Ventricular Dilation ◽  
Hemorrhagic Lesion ◽  
Choice Of Therapy

SUMMARY:Periventricular/intraventricular hemorrhage occurs commonly in the premature newborn. Recent studies indicate an incidence of 35–45%. Following PVH/IVH, the likelihood of developing hydrocephalus is related to the severity of the hemorrhagic lesion. Ventricular dilation may be due to an obliterative arachnoiditis affecting principally the posterior fossa or, less commonly, due to obstruction of flow of cerebrospinal fluid within the ventricular system by clots or other debris. With moderate to severe hemorrhagic lesions, ventricular dilation may occur at the time of PVH/IVH. More commonly, progressive dilation begins one to three weeks following PVH/IVH. The classical clinical signs of hydrocephalus, ie. bulging of anterior fontanelle and inappropriate increase in head circumference, may not appear for days to weeks following onset of ventricular dilation. The precise significance of such normal-pressure hydrocephalus in the genesis of brain injury in the newborn is unknown. Following diagnosis of PVH/IVH, close surveillance of ventricular size with ultrasound scans is indicated. When there is slowly progressive ventricular dilation with normal intracranial pressure, the choice of therapy is made difficult because of frequent spontaneous arrest in such cases. Several modes of therapy have been reported including drugs to decrease the formation of cerebrospinal fluid and the use of serial lumbar punctures. When ventricular dilation is rapid with intracranial hypertension, ventricular drainage is indicated.

Posthemorrhagic hydrocephalus

1984 ◽  
Vol 60 (2) ◽  
pp. 343-347 ◽  
Author(s):  
Laura R. Ment ◽  
Charles C. Duncan ◽  
David T. Scott ◽  
Richard A. Ehrenkranz
Keyword(s):  
At Risk ◽  
Birth Weight ◽  
Intracranial Pressure ◽  
Intraventricular Hemorrhage ◽  
Aqueductal Stenosis ◽  
Cranial Ultrasound ◽  
Special Care Unit ◽  
Posthemorrhagic Hydrocephalus ◽  
Content Type

✓ In addition to seizures and long-term neurodevelopmental handicaps, infants with intraventricular hemorrhage (IVH) are at risk for posthemorrhagic hydrocephalus (PHH), and the incidence of this problem in preterm infants with known IVH has been reported to vary from 25% to 74%. Over a 46-month period, 438 neonates of 1250-gm birth weight or less were admitted to this Newborn Special Care Unit, and 269 survived the first 36 postnatal hours. Of these, 265 patients underwent computerized tomography and/or cranial ultrasound scanning for evaluation of germinal matrix and/or intraventricular hemorrhage (GMH/IVH): 133 infants were found to have experienced GMH/IVH, and 27 of these died within the 1st postnatal week. Of the 95 survivors with GMH/IVH, 43 were known to have GMH only; the other 52 experienced IVH and were therefore at risk for PHH. Patients with GMH/IVH underwent repeat investigations for the development of ventriculomegaly and possible PHH. Only five patients with IVH developed PHH, defined as ventriculomegaly, elevated intracranial pressure, and increasing occipitofrontal head circumference. Serial cranial ultrasound studies of 95 other consecutively admitted patients in this birth-weight range revealed an equal incidence (45%) of low intracranial pressure ventriculomegaly in both the hemorrhage and non-hemorrhage groups, but none of them required shunting for hydrocephalus. One infant with congenital aqueductal stenosis was also identified.

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