User Tools

Site Tools


intraventricular_hemorrhage

Intraventricular hemorrhage

Intraventricular extension of intracerebral hemorrhage (ICH) predicts poor outcome, but the significance of delayed intraventricular haemorrhage (dIVH) is less well defined.

It is the most severe form of stroke.

One hundred thirty-nine (51.3 %) patients with intraventricular hemorrhage developed ventricular dilatation, but only 47 patients (17.34 %) needed shunting. In seven cases, temporary neurosurgical procedures were performed, but in all of them, this was followed by ventriculoperitoneal shunt implantation. The infection rate was 4.25 %, and shunt obstruction rate was 4.25 %. More than 80 % of patients were classified as good or excellent functional state. Mean follow-up period was 38.75 months (SD, 27.09; range, 1-102 months).

Etiology

While intraventricular haemorrhage is frequently found in association with intraparenchymal or subarachnoid haemorrhage, isolated intraventricular haemorrhage (iIVH) is rare in adults and seldom described. Awareness of possible causes is important in order to guide patient management. After elimination of a traumatic cause, numerous aetiologies remain possible. The most frequently found underlying lesions are arteriovenous malformations and aneurysms, but other vascular causes should also be sought, including cavernous malformations and moyamoya disease. Arterial hypertension, anticoagulant use, coagulopathies and certain toxic substances are also associated with iIVH. Finally, iIVH may be caused by intraventricular tumours. In a high number of cases, the cause remains unknown. Vascular and non-vascular causes should be searched through an imaging work-up (with CT angiography, MRI and catheter angiography when necessary) and correlation with clinical information to yield a diagnosis 1).

Traumatic intraventricular hemorrhage

Spontaneous intraventricular hemorrhage

see Intraventricular hemorrhage after ruptured intracranial aneurysms……

Complications

Obstructive hydrocephalus is a relatively common complication of intraventricular hemorrhage resulting in high morbidity and mortality.

Intraventricular hemorrhage (IVH) is a common complication of premature neonates with small birth weight, which often leads to hydrocephalus and treatment with ventriculoperitoneal (VP) shunting procedures. see Intraventricular hemorrhage in the newborn.

Scores

Diagnosis

Clinically, monitoring is performed using 2D ultrasound (US); however, its clinical utility in dilation is limited because it cannot provide accurate measurements of irregular volumes such as those of the ventricles, and this might delay treatment until the patient's condition deteriorates severely.

Kishimoto et al developed a 3-D US system to image the lateral ventricles of neonates within the confines of incubators. They describe an in vivo ventricle volume validation study in two parts: (i) comparisons between ventricle volumes derived from 3-D US and magnetic resonance images obtained within 24 h; and (ii) the difference between 3-D US ventricle volumes before and after clinically necessary interventions (ventricle taps), which remove cerebral spinal fluid. Magnetic resonance imaging ventricle volumes were found to be 13% greater than 3-D US ventricle volumes; however, they observed high correlations (R(2) = 0.99) when comparing the two modalities. Differences in ventricle volume pre- and post-intervention compared with the reported volume of cerebrospinal fluid removed also were highly correlated (R(2) = 0.93); the slope was not found to be statistically significantly different from 1 (p < 0.05), and the y-intercept was not found to be statistically different from 0 (p < 0.05). Comparison between 3-D US images can detect the volume change after neonatal intraventricular hemorrhage. This could be used to determine which patients will have progressive ventricle dilation and allow for more timely surgical interventions. However, 3-D US ventricle volumes should not be directly compared with magnetic resonance imaging ventricle volumes 2).

Case series

Two cases of transient obstructive hydrocephalus caused by obstruction of mesencephalic duct in patients that presented with altered consciousness which resolved spontaneously in a few hours. In very rare cases, obstructive hydrocephalus due to intraventricular hemorrhage may be transient and does not need neurosurgical or invasive procedures for lowering raised intracranial pressure, which otherwise are currently preferred treatment options 3).

1)
Barnaure I, Liberato AC, Gonzalez RG, Romero JM. Isolated intraventricular haemorrhage in adults. Br J Radiol. 2017 Jan;90(1069):20160779. doi: 10.1259/bjr.20160779. Review. PubMed PMID: 27805421.
2)
Kishimoto J, Fenster A, Lee DS, de Ribaupierre S. In Vivo Validation of a 3-D Ultrasound System for Imaging the Lateral Ventricles of Neonates. Ultrasound Med Biol. 2016 Apr;42(4):971-9. doi: 10.1016/j.ultrasmedbio.2015.11.010. Epub 2016 Jan 9. PubMed PMID: 26782271.
3)
Jergović I, Budinčević H, Planjar-Prvan M, Bielen I. TRANSIENT OBSTRUCTIVE HYDROCEPHALUS IN PATIENTS WITH INTRACEREBRAL HEMORRHAGE: REPORT OF TWO CASES. Acta Clin Croat. 2016 Sep;55(3):497-500. PubMed PMID: 29046016.
intraventricular_hemorrhage.txt · Last modified: 2017/10/20 00:40 by administrador