Serial Neurosonography of Haemorrhagic Periventricular Infarction Evolving into Porencephalic Transformation in a Preterm Neonate: A Case Report

Periventricular Leukomalacia (PVL) is the predominant form of white matter injury in preterm neonates. Haemorrhagic Periventricular Infarction (hPVI), a severe variant characterised by venous haemorrhagic transformation of periventricular white matter, carries a significantly poorer neurological prognosis and represents a distinct pathophysiological entity from classical ischaemic PVL. We report a case of a preterm female neonate born at 30 weeks of gestation (birth weight 1.2 kg) following emergency caesarean section for maternal preeclampsia. On day 5 of life, the neonate developed multifocal myoclonic seizures, apnoea, and a significant fall in haemoglobin (14.8 to 8.4 g/dL) with associated thrombocytopenia and coagulopathy. Bedside neurosonography demonstrated a right frontal intraparenchymal haemorrhage with intraventricular extension (Papile Grade IV), with surrounding periventricular echogenicity. Serial neurosonograms documented progressive post-haemorrhagic hydrocephalus and cystic transformation of the periventricular white matter. Non contrast Computed Tomography (CT) at one year confirmed the presence of a porencephalic cyst and persistent ventriculomegaly as chronic sequelae. The child demonstrated spastic left hemiplegia and global developmental delay at follow-up. Serial neurosonography was an indispensable bedside tool for early detection and longitudinal monitoring of hPVI.