The premature infant with PVL is difficult to detect by clinical exam alone. They may only exhibit weakness of the legs in the newborn period. And while the clinical symptoms of IVH, especially with a large bleed, may be dramatic, 25-50% of all babies with IVH have no clinical symptoms at all. This emphasizes the need for screening to be done on all babies at risk for IVH and PVL. Important clues to the presence of IVH, even in the absence of symptoms, may be:

When symptoms associated with an IVH do occur, they most often progress over hours to several days in a non-continuous, stuttering manner which has been termed the "saltatory syndrome". These symptoms include:

One study with serial, detailed neurologic exams showed an abnormally tight popliteal angle in those with IVH (84% compared to 10% without IVH). It was postulated that this was due to meningeal irritation.

The least common clinical syndrome associated with IVH is that of a catastrophic deterioration over minutes to hours. Symptoms here include stupor progressing to coma, apnea, tonic seizures, decerebrate posturing, fixed pupils and a flaccid quadriparesis. Other signs include a bulging anterior fontanelle, decreased hematocrit, hypotension, bradycardia, metabolic acidosis, hyperglycemia and, less commonly, SIADH or diabetes insipidus. This catastrophic syndrome is much more commonly seen in infants with large IVH or PVHI.

Following IVH, the CSF has increased numbers of both RBCs and WBCs, the protein may be in excess of 400-500 mg/dL and the CSF glucose is quite low, often as low as 10 mg/dL. As the weeks following the IVH ensue, the RBC count decreases, but the WBCs may increase to 500-1000/mm3 and there may be persistent and prolonged low CSF glucose.