Effect of germinal matrix hemorrhage on terminal vein position and patency

Abstract

Pathologic studies have suggested that periventricular intraparenchymal hemorrhages (IPH) occur as the result of compression and occlusion of terminal veins (TV) by germinal matrix hemorrhages (GMH). This study used color Doppler ultrasound techniques to test this hypothesis in vivo. Twenty-four infants with 32 intracranial hemorrhages (20 GMH, 12 GMH/IPH) were evaluated during routine sonography with color and duplex Doppler ultrasound using an ACUSON 128 XP unit with 7-MHz linear and vector transducers. Maximum transverse dimension was obtained for each GMH. On coronal color Doppler ultrasound images, TVs were evaluated for displacement, presence of flow, and time average velocity (TAV). Abnormalities of the TV were common with ipsilateral GMH. Of 48 terminal veins evaluated, no flow was identified in 13 (27 %), and flow in a displaced vein was seen in eight (17 %). TV abnormality occurred more frequently with GMH/IPH (90 %) than with GMH alone (52 %), and complete occlusion of the TV was more common in GMH/IPH (82 %) than in GMH alone (16 %, p < 0.002). GMH size correlated with increasing TV abnormality. Mean transverse GMH dimensions with unaffected TV, displaced TV, and occluded TV were 8.2 +/- 1 mm, 10.3 +/- 1 mm, and 12.6 +/- 1 mm, respectively (p = 0.008). A small but significant trend was observed between maximum GMH dimension and decreasing TV velocities (r = - 0.5, p < 0.01). Obstruction of terminal veins by germinal matrix hemorrhage may play an important role in the pathogenesis of periventricular white matter hemorrhage.