Intraventricular hemorrhage is defined as bleeding into the ventricular area in the brain. This is a type of bleeding that can occur in the brain tissue. It shows that blood is present in the brain parts containing cerebrospinal fluids, the ventricles. These ventricles are fluid-filled areas of the brain. This complication occurs mainly in premature newborns. However, intraventricular bleeding has been discovered in some adults.
There are four possible grades to determine if an infant has an intraventricular hemorrhage. The first grade shows that the bleeding is just in the germinal matrix. The second-grade intraventricular hemorrhage shows signs of bleeding in the ventricular system, although there is no enlargement. The ventricles become more prominent in size in the third grade due to blood accumulation. Finally, the bleeding moves to the brain tissues surrounding the be tricked in the fourth grade.
In adults, Intraventricular Hemorrhage (IVH) usually occurs in the setting of aneurysmal subarachnoid hemorrhage or hypertension-related intracerebral hemorrhage. However, a more significant percentage of intraventricular bleeding starts during the first 72 hours of birth.
According to the U.S National Library of Medicine, 33% of babies with intraventricular hemorrhage die. Intraventricular Haemorrhage can be discovered early after childbirth through a head ultrasound. For quick detection of complications, babies that are premature(born at lesser than 32 weeks) and are underweight(less than 1500g) are required to undergo a head ultrasound within a week of birth. They are also to undergo intraventricular hemorrhage assessment. All babies, premature or not, with symptoms of the IVH are required to go through a head ultrasound.
In adults, a CT scan is used for diagnosing intraventricular hemorrhage. Vascular imaging is required for patients with no family history of intraventricular hemorrhage.
Types of Intraventricular Haemorrhage
Intraventricular hemorrhage could be divided into two, primary and secondary.
Primary Intraventricular Haemorrhage
In this case, the bleeding is restricted to the ventricular system only with little or no parenchymal blood. It occurs more in premature babies.
Out of all intraventricular hemorrhage cases, about 30% are primary. It could be caused by tumors (especially in the choroid plexus), aneurysms, hypertension, or physical trauma.
Secondary Intraventricular Haemorrhage
Secondary Intraventricular Hemorrhage is a type of Intraventricular Hemorrhage that occurs in adults. It is usually caused by basal ganglia hypertensive hemorrhage or subarachnoid hemorrhage with ventricular reflux in adults. 70% of known intraventricular hemorrhages are secondary.
Causes of Intraventricular Hemorrhage
Intraventricular could occur in preterm newborns and adults. Their causes are grouped in two below:
Preterm/ Infants
● Premature newborns have more tendency to have intraventricular bleeding, especially if they are underweight at birth—the lesser the weight and the more the prematurity, the higher the possibility of Intraventricular hemorrhage. The bleeding occurs in their germinal matrix and is caused by the change in the cellular structures of the brain as it grows. The germinal matrix is a cellular and vascularized part of the brain. Intraventricular bleeding starts from the terminal matrix because it has no actual structure. A more significant percentage of intraventricular bleeding starts during the first 72 hours of birth.
● Damaged blood vessels: Premature infants tend to have blood vessels that are not entirely developed, and these blood vessels become punctured or ruptured and begin to leak. Breathing complications such as low oxygen levels or unstable blood pressure can damage the blood vessel.
● Pneumothorax: This is air trapped around the lungs area, usually at the outer part. This could be because of pressure on the lungs or diseases like tuberculosis.
● Intraventricular hemorrhage could be caused if the mother has a medical history of hypertension or possible infections during the pregnancy.
● Other causes of intraventricular hemorrhage are complications during child delivery, other bleeding problems, or genetic history
Adults
● In adults, intraventricular hemorrhage could result from a hemorrhagic stroke or physical trauma from accidents, blow impacts to the head, falls, etc.
● Weak blood vessels are known as brain aneurysms.
● High blood pressure could lead to a stroke.
● Thin and weak capillaries, called cavernous malformations.
Symptoms Of Intraventricular Hemorrhage
There are often no exact symptoms of possible intraventricular hemorrhage in infants. Although, some symptoms may be noticed. It could be constant fatigue, too much sleeping, and possible sluggishness in affected preterms.
Other symptoms are swollen fontanelles, decreased reflex, irregular breathing, decreased muscle tone, reduced heart rate, or abnormal eye and body movement.
In adults, symptoms such as nausea, headache, vomiting, loss of consciousness, focal or general seizures are noticed.
Intraventricular Hemorrhage Complications
If not treated, intraventricular hemorrhage could lead to constant seizures, long-term brain injuries, cerebral palsy, brain damage, and eventually, death.
How To Prevent Intraventricular Hemorrhage
Maintaining Standard Blood Pressure Level
Before birth, the child’s blood pressure level must be put under close monitoring. This is because high and low blood pressure can result in intraventricular
bleeding after birth. However, constant monitoring and the use of medications can make the blood pressure stable.
Steroids During Pregnancy
Mothers are administered certain steroid medications to reduce the possibility of intraventricular hemorrhage. In addition, these steroids help the lungs of the baby mature. Therefore, only mothers who have shown early birth signs are given these steroids. The steroids are introduced between the 24th and 34th week of gestation.
Good Neutral Position
The baby’s head must be placed in a way that keeps an even blood flow to the brain. Examples of these positions could be placing the baby on its back, tummy, or sides. This step might help prevent intraventricular bleeding.
Avoid Physical Trauma
Intraventricular hemorrhage could occur in adults through physical trauma to the head. This could be during sports activities or by accidents. Therefore, it is advisable to play safe by avoiding sudden falls and blows to the head. This method is, however, not guaranteed because accidents happen.
Is Intraventricular Hemorrhage Treatable?
Currently, there is no known treatment for intraventricular hemorrhage. However, other medical conditions could be treated to prevent the complication of the IVH. The blood pressure would be controlled, and the infant would provide oxygen. To reduce the IVH risk, steroids such as corticosteroid medications are given to mothers before child delivery. They are administered during the gestation period to mothers with the risk of early childbirth.
In adults, a spinal tab procedure is used to drain extra fluids from the ventricles. It is done by inserting into the lower spinal column.
Note that intraventricular hemorrhage can stop with time, the bleeding stops, and the blood vessels heal gradually. However, if the brain tissue is damaged, it doesn’t heal and can lead to long-term complications.
Conclusion
Intraventricular hemorrhage is a brain bleeding disorder in the ventricular system. It occurs mainly in premature babies but is also common in adults. Usually caused by difficulty during delivery, trauma to the head, breathing issue, weak blood vessels and capillaries, intraventricular hemorrhage has no cure. It can, however, be managed and prevented. Therefore, preventive measures are taken before birth by medical practitioners. Intraventricular hemorrhage can only be prevented before its occurrence.
After birth, babies with IVH are treated for medical conditions that come with it. This minimizes complications and gives hope for healing. Intraventricular bleeding can heal gradually, and blood vessels heal, stopping the bleeding.
