Intraventricular hemorrhage

Introduction Intraventricular hemorrhage (IVH) frequently complicates subarachnoid hemorrhage (SAH) and intracranial hemorrhage (ICH). In both settings, IVH is a significant and independent contributor to morbidity and mortality, yet therapy directed at ameliorating intraventricular clot has been limited (1-6). Mechanisms of IVH-induced brain injury include increased intracranial pressure (ICP) and ischemic encephalopathy by virtue of mass effect from hemorrhage or associated hydrocephalus due to ventricular outflow obstruction. More recently, direct toxicity of blood products within the ventricle has been implicated in mechanisms by which IVH exerts deleterious effects (7). We review the topic intraventricular hemorrhage, articulating the scope of the problem, standard and investigational therapies, management issues, and relevant questions for future research. Epidemiology Brain hemorrhage is the stroke subtype with the highest morbidity and mortality. Respectively, ICH and SAH account for about 15% and 5% of the 750 000 strokes occurring yearly in the United States, totaling more than 45 000 patients per year (8-10). Approximately 45% of spontaneous ICH and 25% of aneurysmal SAH extend into the ventricles (8,10-12). For patients with both ICH and significant IVH, the expected mortality is 50-80% (13,14). Patients with severe IVH are twice as likely to have poor outcomes (a modified Rankin scale [mRS] score of 4-6 at hospital discharge) and nearly three times more likely to die than their cohorts without IVH (7).