Periventricular white matter hemorrhage (PWMH) was frequently found in very low-birth weight infants with perinatal asphyxia or respiratory distress. Primary PWMH with or without intraventricular rupture was found at the deep arterial borderzones of the frontal or occipital lobes. The ischemic tissue damage induced by hypoperfusion may be a predisposing factor for PWMH. However, the high incidence of visceral intravascular thrombi and the fan-shaped appearance of hemorrhage suggested venous hemorrhagic infarction. Venous thrombosis with coagulopathy may be an important factor for the pathogenesis of PWMH.