RAPIDLY PROGRESSIVE ENLARGEMENT OF THE 4TH VENTRICLE IN THE PRETERM INFANT WITH POSTHEMORRHAGIC VENTRICULAR DILATATION

Six preterm infants who developed disproportionate enlargement of the 4th ventricle during the neonatal period, associated with post-haemorr hagic ventricular dilatation (PHVD), before shunt placement are report ed. Five of the six preterm infants developed cyanotic spells and/or b radycardias at the time of rapid enlargement of the 4th ventricle, sug gestive of raised posterior fossa pressure, which resolved following i nsertion of and drainage from a subcutaneous reservoir. In one of the three survivors an isolated 4th ventricle was subsequently diagnosed l ater in infancy, requiring drainage. These data suggest that a combina tion of an enlarged 4th ventricle on ultrasound and cyanotic spells an d/or bradycardias should lead to rapid release of raised pressure in t he posterior fossa. Long-term follow-up of these children is necessary , as isolation of the 4th ventricle can subsequently develop.