Intraventricular hemorrhage
Anatomic relationships and clinical implications
Abstract
Background: Spontaneous intracerebral hemorrhage (ICH) is frequently associated with intraventricular hemorrhage (IVH), which is an independent predictor of poor outcome. The purpose of this study was to examine the relationship between ICH volume and anatomic location to IVH, and to determine if ICH decompression into the ventricle is truly beneficial.
Methods: We retrospectively analyzed the CT scans and charts of all patients with ICH admitted to our stroke center over a 3-year period. Outcome data were collected using our prospective stroke registry.
Results: We identified 406 patients with ICH. A total of 45% had IVH. Thalamic and caudate locations had the highest IVH frequency (69% and 100%). ICH volume and ICH location were predictors of IVH (p < 0.001). Within each location, decompression ranges (specific volume ranges where ventricular rupture tends to occur) were established. Patients with IVH were twice as likely to have a poor outcome (discharge modified Rankin scale of 4 to 6) (OR 2.25, p = 0.001) when compared to patients without IVH. Caudate location was associated with a good outcome despite 100% incidence of IVH. Spontaneous ventricular decompression was not associated with better outcome, regardless of parenchymal volume reduction (p = 0.72).
Conclusions: Intraventricular hemorrhage (IVH) occurs in nearly half of patients with spontaneous intracerebral hemorrhage (ICH) and is related to ICH volume and location. IVH is likely to occur within the “decompression ranges” that take into account both ICH location and volume. Further, spontaneous ventricular decompression does not translate to better clinical outcome. This information may prove useful for future ICH trials, and to the clinician communicating with patients and families.
GLOSSARY: ANOVA = analysis of variance; EVD = external ventricular drainage; HSD = honestly significant differences; ICC = interclass correlation coefficient; ICH = intracerebral hemorrhage; IVH = intraventricular hemorrhage; LOS = length of stay; mRS = modified Rankin Scale.
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REFERENCES
1.
Gates PC, Barnett HJ, Vinters HV, Simonsen RL, Siu K. Primary intraventricular hemorrhage in adults. Stroke 1986;17:872–877.
2.
Lang EW, Ren Ya Z, Preul C, et al. Stroke pattern interpretation: the variability of hypertensive versus amyloid angiopathy hemorrhage. Cerebrovasc Dis 2001;12:121–130.
3.
Naff NJ. Intraventricular hemorrhage in adults. Curr Treat Options Neurol 1999;1:173–178.
4.
Naff NJ, Tuhrim S. Intraventricular hemorrhage in adults: complications and treatment. New Horiz 1997;5:359–363.
5.
Woo D, Broderick JP. Spontaneous intracerebral hemorrhage: epidemiology and clinical presentation. Neurosurg Clin N Am 2002;13:265–279.
6.
Flaherty ML, Woo D, Haverbusch M, et al. Racial variations in location and risk of intracerebral hemorrhage. Stroke 2005;36:934–937.
7.
Fisher CM. The pathologic and clinical aspects of thalamic hemorrhage. Trans Am Neurol Assoc 1959;84:56–59.
8.
Freytag E. Fatal hypertensive intracerebral haematomas: a survey of the pathological anatomy of 393 cases. J Neurol Neurosurg Psychiatry 1968;31:616–620.
9.
Furlan AJ, Whisnant JP, Elveback LR. The decreasing incidence of primary intracerebral hemorrhage: a population study. Ann Neurol 1979;5:367–373.
10.
Kase CS, Williams JP, Wyatt DA, Mohr JP. Lobar intracerebral hematomas: clinical and CT analysis of 22 cases. Neurology 1982;32:1146–1150.
11.
Kunitz SC, Gross CR, Heyman A, et al. The pilot Stroke Data Bank: definition, design, and data. Stroke 1984;15:740–746.
12.
Mutlu N, Berry RG, Alpers BJ. Massive Cerebral Hemorrhage. Clinical and Pathological Correlations. Arch Neurol 1963;8:644–661.
13.
Stein RW, Kase CS, Hier DB, et al. Caudate hemorrhage. Neurology 1984;34:1549–1554.
14.
Walshe TM, Davis KR, Fisher CM. Thalamic hemorrhage: a computed tomographic-clinical correlation. Neurology 1977;27:217–222.
15.
Wiggins WS, Moody DM, Toole JF, Laster DW, Ball MR. Clinical and computerized tomographic study of hypertensive intracerebral hemorrhage. Arch Neurol 1978;35:832–833.
16.
Bhattathiri PS, Gregson B, Prasad KS, Mendelow AD. Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl 2006;96:65–68.
17.
Diamond P, Gale S, Stewart K. Primary intracerebral haemorrhage: clinical and radiologic predictors of survival and functional outcome. Disabil Rehabil 2003;25:689–698.
18.
Hallevy C, Ifergane G, Kordysh E, Herishanu Y. Spontaneous supratentorial intracerebral hemorrhage: criteria for short-term functional outcome prediction. J Neurol 2002;249:1704–1709.
19.
Lisk DR, Pasteur W, Rhoades H, Putnam RD, Grotta JC. Early presentation of hemispheric intracerebral hemorrhage: prediction of outcome and guidelines for treatment allocation. Neurology 1994;44:133–139.
20.
Portenoy RK, Lipton RB, Berger AR, Lesser ML, Lantos G. Intracerebral haemorrhage: a model for the prediction of outcome. J Neurol Neurosurg Psychiatry 1987;50:976–979.
21.
Tuhrim S, Horowitz DR, Sacher M, Godbold JH. Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage. Crit Care Med 1999;27:617–621.
22.
Young WB, Lee KP, Pessin MS, Kwan ES, Rand WM, Caplan LR. Prognostic significance of ventricular blood in supratentorial hemorrhage: a volumetric study. Neurology 1990;40:616–619.
23.
Steiner T, Diringer MN, Schneider D, et al. Dynamics of intraventricular hemorrhage in patients with spontaneous intracerebral hemorrhage: risk factors, clinical impact, and effect of hemostatic therapy with recombinant activated factor VII. Neurosurgery. 2006;59:767–773, discussion 773–764.
24.
Zimmerman RD, Maldjian JA, Brun NC, Horvath B, Skolnick BE. Radiologic estimation of hematoma volume in intracerebral hemorrhage trial by CT scan. AJNR Am J Neuroradiol 2006;27:666–670.
25.
Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke 1996;27:1304–1305.
26.
Hijdra A, Brouwers PJ, Vermeulen M, van Gijn J. Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke 1990;21:1156–1161.
27.
Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 1993;24:987–993.
28.
Vajramani GV, Jones G, Bayston R, Gray WP. Persistent and intractable ventriculitis due to retained ventricular catheters. Br J Neurosurg 2005;19:496–501.
29.
Lo CH, Spelman D, Bailey M, Cooper DJ, Rosenfeld JV, Brecknell JE. External ventricular drain infections are independent of drain duration: an argument against elective revision. J Neurosurg 2007;106:378–383.
30.
Naff NJ, Carhuapoma JR, Williams MA, et al. Treatment of intraventricular hemorrhage with urokinase: effects on 30-Day survival. Stroke 2000;31:841–847.
31.
Naff NJ, Hanley DF, Keyl PM, et al. Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, prospective, randomized, double-blind, controlled trial. Neurosurgery 2004;54:577–583; discussion 583–574.
32.
Fountas KN, Kapsalaki EZ, Parish DC, et al. Intraventricular administration of rt-PA in patients with intraventricular hemorrhage. South Med J 2005;98:767–773.
33.
Mayer SA, Brun NC, Broderick J, et al. Safety and feasibility of recombinant factor VIIa for acute intracerebral hemorrhage. Stroke 2005;36:74–79.
34.
NovoNordisk. Phase 3 stroke trial shows that NovoSeven® reduces bleeding in the brain, but does not improve long-term clinical outcomes. Stock Exchange Announcement no. 5/2007.
35.
Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997;28:1–5.
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Published online: March 10, 2008
Published in print: March 11, 2008
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