Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
권호 표지

Non-Traumatic Primary Intraventricular Hemorrhage

  • Ahn, Sang-Wook (Department of Neurosurgery, College of Medicine, Ewha Womans University) ;
  • Hwang, Sung-Kyun (Department of Neurosurgery, College of Medicine, Ewha Womans University)
  • Published : 2010.09.30
⟨ Previous Next ⟩

Abstract

Objective : Non-traumatic primary intraventricular hemorrhage (PIVH) in adults has rarely been reported. This study aimed to identify clinical features, risk factors, and neurological outcomes of PIVH in adults. Methods : We retrospectively reviewed the clinical data, complementary examinations, outcomes, and computed tomography (CT) scans for non-traumatic PIVH occurring between 2002 and 2008 at our institutions. We defined PIVH as "a hematoma caused by non-traumatic factors, either confined completely within the ventricular system or arising within 15 mm of the ventricular wall." Result : Among the 19 PIVH patients treated in our institutions, the mean age was 55.5 years (range 19-81), and the male to female ratio was 0.72. Symptom onset was abrupt in 18 patients and progressive in 1. The most frequent complaint was headache (47%) followed by nausea and vomiting (38%). Seven patients (38%) had mental status impairment, ranging from stupor to semicoma. The causes of PIVH were unknown, although arteriography showed a suspicious vascular malformation in 1 patient. Seven (37%) patients died or entered a vegetative state. All survivors became functionally independent. No patients received ventriculoperitoneal shunts. Two of the surviving patients had limb weakness. Overall, 7 patients (37%) had GOS scores 1 to 2 and 12 (63%) had GOS scores 3 to 5. Conclusion : Although present technology allows clinicians to reach a diagnosis in many PIVH patients, the condition's etiology remains unknown, and its clinical manifestations vary, due to the rarity of these cases. Overall results and prognoses seem relatively better than in secondary intraventricular hemorrhage. However, evaluating and clarifying the nature of PIVH requires experience with more cases.

Keywords

References

  1. Angelopoulos M, Gupta SR, Azat Kia B. Primary intraventricular hemorrhage in adults: clinical features, risk factors, and outcome. Surg Neurol 44:433-7, 1995 https://doi.org/10.1016/0090-3019(95)00261-8
  2. Brott T, Broderick J, Kothari R, Barsan W,Tomsic T, Sauerbeck L, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 28:1-5, 1997 https://doi.org/10.1161/01.STR.28.1.1
  3. Darby DC, Donnan CA, Saling MA, Walsh KW, Bladin PF. Primary intraventricular hemorrhage: clinical and neuropsychological finding in a prospective stroke series. Neurology 38:68-75, 1988 https://doi.org/10.1212/WNL.38.1.68
  4. Findlay M, Croce MCA, Weir B. Treatment of intraventricular hemorrhage with tissue plasminogen activator. Neurosurgery 32:941-7, 1993 https://doi.org/10.1227/00006123-199306000-00010
  5. Fogelholm R, Nuutila M, Vuorela AL. Primary intracerebral hemorrhage in the Jyvaskyla region, central Finland 1985?89:incidence, case fatality rate, and functional outcome. J Neurol Neurosurg Psych 55:546-552, 1992 https://doi.org/10.1136/jnnp.55.7.546
  6. Gates PC, Barnett HJM, Vinters HV, Simonsen RL, Siu K. Primary intraventricular hemorrhage in adults. Stroke 17:872-7, 1986 https://doi.org/10.1161/01.STR.17.5.872
  7. Goh KY, Poon WS. Recombinant tissue plasminogen activator for the treatment of spontaneous adult intraventricular hemorrhage. Surg Neurol 50:526-32, 1998 https://doi.org/10.1016/S0090-3019(97)00504-1
  8. Hallevi H, Albright KC, Aronowski J, Barreto AD, Martin-Schild S, Khaja AM, et al. Intraventricular hemorrhage: Anatomic relationships and clinical implications. Neurology 70:848-52, 2008 https://doi.org/10.1212/01.wnl.0000304930.47751.75
  9. Hill MD, Silver FL, Austin PC, Tu JV. Rate of stroke recurrence in patients with primary intracerebral hemorrhage. Stroke 31:123-7, 2000 https://doi.org/10.1161/01.STR.31.1.123
  10. Little JR, Blomquist GA Jr, Ethier R. Intraventricular hemorrhage in adults. Stroke 8;143-9, 1987
  11. Lee KS, Bae HG, Yun IG. Recurrent intracerebral hemorrhage due to hypertension. Neurosurgery 26:586-90, 1990 https://doi.org/10.1227/00006123-199004000-00005
  12. Liu Y, Yang Y, Zhang Q, Zhang W, Zhu S, Li X, et al. A study of classification of spontaneous intraventricular haemorrhage: a report of 324 cases. J Clin Neurosci 5:182-5, 1998 https://doi.org/10.1016/S0967-5868(98)90035-2
  13. Marti-Fabregas J, Piles S, Guardia E, Marti-Vilalta JL. Spontaneous primary intraventricular hemorrhage: clinical data, etiology and outcome. J Neurol 246:287-91, 1999 https://doi.org/10.1007/s004150050348
  14. Maruishi M, Shima T, Okada Y, Nishida M, Yamane K, Okita S. Clinical findings in patients with recurrent intracerebral hemorrhage. Surg Neurol 44:444-9, 1995 https://doi.org/10.1016/0090-3019(95)00300-2
  15. Mayer SA, Brun NC, Broderick J, Stephen D, Michael ND, Brett ES, et al. Safety and feasibility of recombinant factor VIIa for acute intracerebral hemorrhage. Stroke 36:74-9, 2005 https://doi.org/10.1161/01.STR.0000149628.80251.b8
  16. Naff NJ. Intraventricular hemorrhage in adults. Curr Treat Options Neurol 1:173-8, 1999 https://doi.org/10.1007/s11940-999-0001-0
  17. Naff NJ, Carhuapoma JR, Williams MA, Bhardwaj A, Ulatowski JA, Bederson J, et al. Treatment of intraventricular hemorrhage with urokinase: effects on 30-day survival. Stroke 31:841-7, 2000. https://doi.org/10.1161/01.STR.31.4.841
  18. Naff NJ, Hanley DF, Keyl PM, Tuhrim S, Kraut M, Bederson J, et al. Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, prospective, randomized, doubleblind, controled trial. Neurosurgery 54:577-84, 2004. https://doi.org/10.1227/01.NEU.0000108422.10842.60
  19. Passero S, Ulivelli M, Reale F. Primary intraventricular haemorrhage in adults. Acta Neurol Scand 105:115-9, 2002 https://doi.org/10.1034/j.1600-0404.2002.1o118.x
  20. Steiner T, Diringer MN, Schneider D, Mayer SA, Begtrup K, Broderick J, 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 59:767-74, 2006 https://doi.org/10.1227/01.NEU.0000232837.34992.32
  21. Young WB, Lee KP, Pessin MS, Kwan ES, Rand WM, Caplan LR. Prognostic significance of ventricular blood in supratentorial hemorrhage: a volumetric study. Neurology 40:616-9, 1990 https://doi.org/10.1212/WNL.40.4.616
  22. Wakai S, Kumakura N, Nagai M. Lobar intracerebral hemorrhage. A clinical, radiographic, and pathological study of 29 consecutive operated cases with negative angiography. J Neurosurg 76:231-8, 1992 https://doi.org/10.3171/jns.1992.76.2.0231
  23. Zhu XL, Chan MS, Poon WS. Spontaneous intracranial hemorrhage: which patients need diagnostic cerebral angiography? A prospective study of 206 cases and review of the literature. Stroke 28:1406-9, 1997 https://doi.org/10.1161/01.STR.28.7.1406