Subependymal hemorrhage (SEH) into germinal matrix

Subependymal hemorrhage or germinal matrix hemorrhage occurs in premature infants with very low birth weight (<1500g). The germinal matrix in the immature brain is located around the lateral ventricles and it contains a fine network of fragile blood vessels, which are sensitive to ischemia and changes in perfusion pressure. Subependymal hemorrhage in premature neonates can be easily assessed by ultrasound and be divided into four grades.

Grade Description
Grade I hemorrhage confined to the germinal matrix
Grade II intraventricular hemorrhage (hemocephalus) without ventricular dilation
Grade III intraventricular hemorrhage (hemocephalus) with ventricular dilation
Grade IV intraventricular rupture with hemorrhage into the surrounding white matter


1. Bowerman R, Donn S, Silver T, Jaffe M. Natural history of neonatal periventricular/intraventricular hemorrhage and its complications: sonographic observations. American Journal of Roentgenology. 1984 Nov 1;143(5):1041–52.
2. Radack DM, Baumgart S, Gross GW. Subependymal (grade 1) intracranial hemorrhage in neonates on extracorporeal membrane oxygenation. Frequency and patterns of evolution. Clin Pediatr (Phila). 1994 Oct;33(10):583–7.

3. Smith WL, McGuinness G, Cavanaugh D, Courtney S. Ultrasound screening of premature infants: longitudinal follow-up of intracranial hemorrhage. Radiology. 1983 May 1;147(2):445–8.

Alberta Stroke Programme Early CT Score (ASPECTS)

ASPECTS is a quantitative topographic prognostic score based on unenhanced CT scan in patients with middle cerebral artery infarction. For each from 10 segments, one point is deducted from initial 10 points for each segment with detectable ischemic changes. A score ≤7 points predicts worse functional outcome at 3 months and an increased risk of symptomatic intracranial hemorrhage.



Capsula interna

Adams classification of diffuse axonal injury, DAI

Grading of Diffuse Axonal Injury as proposed by Adams et al.

Grade I:

  • axonal injury limited to white matter (grey-white matter interfaces)

Grade II:

  • Grade I + involvement of corpus callosum

Grade III:

  • Grade II + involvement of brainstem


1. Adams JH, Doyle D, Ford I, Gennarelli TA, Graham DI, Mclellan DR. Diffuse axonal injury in head injury: Definition, diagnosis and grading. Histopathology. 1989;15(1):49–59.

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