Rapidly progressive enlargement of the fourth ventricle in the preterm infant with post‐haemorrhagic ventricular dilatation

Abstract

Six preterm infants who developed disproportionate enlargement of the 4th ventricle during the neonatal period, associated with post-haemorrhagic ventricular dilatation (PHVD), before shunt placement are reported. Five of the six preterm infants developed cyanotic spells and/or bradycardias at the time of rapid enlargement of the 4th ventricle, suggestive of raised posterior fossa pressure, which resolved following insertion of and drainage from a subcutaneous reservoir. In one of the three survivors an isolated 4th ventricle was subsequently diagnosed later in infancy, requiring drainage. These data suggest that a combination of an enlarged 4th ventricle on ultrasound and cyanotic spells and/or bradycardias should lead to rapid release of raised pressure in the posterior fossa. Long-term follow-up of these children is necessary, as isolation of the 4th ventricle can subsequently develop.

The entity of the trapped fourth ventricle

“…An acute or subacute isolation of the fourth ventricle is more rarely detected and is associated with infection or hemorrhage at the time of diagnosis. [ 11 23 25 ]…”

“…The most common clinical scenario relevant to these patients is that of an infant with a history of prematurity, who developed IVH and was treated with shunt placement. [ 9 10 11 12 ] An early bibliographic report exists, which described and correlated the occurrence of acquired aqueductal stenosis in cases with known, and shunted, communicating hydrocephalus, on the basis of pneumoencephalographic findings. [ 7 ] To the best of our knowledge, Hawkins et al .…”

Cranial ultrasound findings in preterm germinal matrix haemorrhage, sequelae and outcome

“…In some cases, the fourth ventricle is isolated from CSF circulation by combined obstruction of aqueduct and the fourth ventricle outlets. 59,95,96 One relevant advantage of CUS is the possibility to perform repeated scans in order to timely detect PHVD and to follow its evolution before and after treatment. Initial dilatation is often transient with a stable phase followed by regression of dilatation within days or a few weeks.…”

Unilateral posthaemorrhagic hydrocephalus in the neonatal period or later in infancy

“…In a small number of cases lack of communication can be noted between the 3rd and the 4th ventricles due to a block at the level of the aqueduct. Rapid enlargement of the 4th ventricle can also occasionally occur in preterm infants with PHVD (12). If stabilization of PHVD does not occur within the next 10-14 d, in spite of daily lumbar punctures, or when lumbar punctures are not successful due to lack of communication, a Rickham reservoir is inserted (13).…”

“…Case reports Case 1. This girl was one of twins, born at 28 wk GA with a birthweight of 960 g (P [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] ). She developed a left-sided IVH with rapidly progressive ventricular dilatation of the affected side.…”