Echogenic haemorrhage at the caudothalamic groove on cranial ultrasound, graded by extension into the ventricles, ventricular dilatation and parenchymal (periventricular venous) infarction.
Orient first
- A preterm problem (especially under 32 weeks), most within the first 72 hours of life.
- Papile grading I–IV is still used; many describe grade IV as periventricular haemorrhagic infarction.
- Post-haemorrhagic ventricular dilatation is measured and followed.
Acquire the study
- Cranial ultrasound through the anterior fontanelle with a high-frequency curvilinear probe: six coronal and five sagittal planes; mastoid fontanelle views for the posterior fossa.
The manoeuvre
- Coronal and parasagittal views: echogenic focus at the caudothalamic groove (grade I).
- Blood within the lateral ventricles: filling less or more than 50% of the ventricle.
- Ventricular index and anterior horn width in mm on the coronal plane at the foramen of Monro.
- Periventricular parenchyma: fan-shaped echogenicity (venous infarction) on the side of the haemorrhage.
- Mastoid view: cerebellar haemorrhage.
What confirms it
- Echogenic haemorrhage at the germinal matrix or in the ventricles in a preterm neonate, graded and measured.
What licenses you to exclude it
- Normal caudothalamic grooves and ventricles on a complete study exclude significant IVH at that time; repeat scans follow protocol.
The classic misread
- Calling the normal choroid plexus haemorrhage — the choroid does not extend into the frontal horn anterior to the foramen of Monro.
- Missing cerebellar haemorrhage without mastoid views.