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| Germinal Plate Hemorrhage (GPH) |
| Etiology •Related to the presence of the germinal plate containing large bore capillaries with little surrounding matrix. •Premature infants with immature lungs who develop respiratory distress syndrome along with clinical crises characterized by hypotension followed by hypertension experience increased blood flow throung the large bore vessels in the germinal plate. |
| Pathogenesis •Seen when premature infants have a period of hypotension followed by a period of hypertension and a markedly increased blood flow through the large, thin walled blood vessels in the germinal plate due to the the inability of these vessels to autoregulate in prematures. •Rupture into the ventricles leads to hydrocephalus from organization of blood in the ventricles, aqueduct of Sylvius or subarachnoid space., |
| Epidemiology •Seen only in premature infants with a residual germinal plate, usually those under 35 weeks gestation. •Percent affected decreases with increasing gestational age •In the past was seen in 40% of infants under 1500 gms. •Because of better treatment in the neonatal intensive care units is seen less frequently now. |
| General Gross Description •GPH arises from the the germinal plate beneath the lateral ventricles over the caudate nucleus in infants under 35 weeks gestation at birth. •Can rupture into the ventricles. •The younger the gestational age at birth, the more commonly GPH is seen. •If the patient survives, the GPH will appear as a brownish stained cyst. |
| General Microscopic Description •Microscopically, red blood cells are seen between germinal plate neuroblasts and glioblasts which are small cells with uniform oval nuclei and no evident cytoplasm and extend from the large, thin-walled blood vessels in the area •In older lesions, there is necrosis, infiltration by macrophages, and hemosiderin in the area of the hemorrhage leading to a cyst with macrophages, astrocytes and hemosidering about it. |
| Clinical Correlation •The infants are premature, have respiratory distress syndrome and often have had a period of hypotension followed by a period of hypertension. •They may show varying degrees of lethargy or coma depending on the size of the hemorrhage. •If the hemorrhage is large the patient may be slow in development and retarded. •With rupture into the ventricles the infant may die or develop hydrocephalus. |
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 436 • Poirer J et.al. Manual of basic neuropathology. Philadelphia: Saunders, 1990, pp. 206. |
| Germinal Plate Hemorrhage (GPH) |
| Synopsis by: M.L. Grunnet M.D. (TX1615M37000)[33] |
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