Cranial Sonography (CUS) Instruction Manual

Intraventricular Hemorrhage (IVH) is diagnosed and categorized by previously published Papile and Volpe criteria.

• Grade I IVH, hemorrhage is confined to the germinal matrix.
• Grade II IVH, hemorrhage is present in a no distended lateral ventricle, and fills less than 50% of the ventricular parasagittal diameter
• Grade III IVH is present in a distended lateral ventricle and fills greater than 50% of the lateral ventricle.
• Grade 4 IVH Periventricular hemorrhagic infarction) when a hemorrhagic lesion is seen in the periventricular white matter. Lesions may be unilateral or bilateral. When bilateral, they typically are asymmetric. It is always associated with an ipsilateral IVH. When IVH is bilateral, it usually is larger on the side ipsilateral to the PVHI

Locations for US diagnosis in IVH-4 /hyperechogenicity/Cysts (Parasagittal view):

Midline shift:

Focal Intraparenchymal Cyst:   

Focal Intraparenchymal Cyst: appears on US as a large, generally single and unilateral porencephalic cyst, occurring as a sequela (evolution) of intraparencymal grade 4 IVH (periventricular hemorrhagic infarction). The large cyst often but not invariably communicates with the lateral ventricle.

Cystic periventricular leukomalacia (PVL) :  

Cystic Periventriculr Leukomalacia appears on US  as echolucencies (cysts) in the periventricular white matter dorsolateral to the lateral ventricles, usually bilateral and symmetrical. Although PVL may be sometimes associated with IVH or PHH, it is not a direct evolution of a intraparenchymal periventricular hemorrhagic infarction (grade 4 IVH).