Prognostic Factors in Spontaneous Primary Intraventricular Hemorrhage

OBJECTIVE: TA retrospective study is performed on 28 patients with primary intraventricular hemorrhage(PIVH) to examine the outcome and prognostic factors associated with this disorder. METHODS: Clinical data collected between 1998 and 2002 was used in the present study. The outcomes of these patients were compared by age, etiology, initial Glasgow Coma Score(GCS), Graeb's score, ventriculocranial ratio(VCR), hemorrhagic dilation of the third ventricle, and hemorrhagic dilation of the fourth ventricle. The Glasgow Outcome Scale(GOS) at discharge was used for the comparison of outcomes. RESULTS: The mean age of these patients was 48.4+/-17.4 years. The underlying causes of PIVH were hypertension(53.6%), moyamoya disease(17.9%), arteriovenous malformation(10.7%), cerebral aneurysm(7.1%), and unknown(10.7%). The age and etiology were not correlated with outcome. Patients with a GCS of 13-15 showed a good outcome in 90.5%(p or =0.23) showed a poor outcome in 64.3%(p<0.05). Patients with a Graeb's score of 9-12 showed a poor outcome in 87.5%(p<0.05). Those with hemorrhagic dilatation of the third ventricle showed a poor outcome in 80.0%, and those with hemorrhagic dilatation of the fourth ventricle showed a poor outcome in 85.7%(p<0.05). The overall mortality rate was 17.9%. CONCLUSION: Low initial GCS, high Graeb's score, high VCR, and hemorrhagic dilatation of the third ventricle or the fourth ventricle are correlated with poor outcome in PIVH.

Clinical-Computed Tomographic Correlation of Spontaneous Intraventricular Hemorrhage Patients

Little has been known about clinical outcome in computed tomography(CT) documented intraventricular hemorrhage (IVH), especially in the third and fourth ventricles. A series of 114 patients with IVH in spontaneous intracranial hemorrhage diagnosed by CT, from January 1994 to December 1996, were studied retrospectively. The clinical findings, especially Glasgow Outcome Score(GOS), of these patient were compared with computed tomographic parameters on the Graeb's score, evidence of third ventricular hemorrhage, patency of fourth ventricle and hemorrhagic dilatation of fourth ventricle. The results were as following: 1) The underlying etiologies, in descending order, were hypertensive intracerebral hemorrhage(61.4%), subarachnoid hemorrhage(16.7%), moyamoya disease(13.2%), vascular malformation(5.3%), and unknown cause(3.5%). Moyamoya disease was the most common cause of pure IVH. 2) The bifrontal index (BFI), as an indicator of acute hydrocephalus after IVH, was closely correlated with consciousness level on admission, but not with GOS. 3) Graeb's score was correlated with GOS, but not with the volume of the intracerebral hematoma. 4) The third ventricular hemorrhage was associated with a worse outcome and hemorrhagic dilatation(>10.0mm) was associated with high mortality. 5) The absence of patency and the lateral dilatation(>20.0mm) in the fourth IVH was correlated with outcome. 6) In patients having the hemorrhagic dilatation of the fourth ventricle, Graeb's score and volume of intracerebral hematoma did not affect the outcome. In conclusion, Graeb's score, hemorrhagic dilatation of third ventricle, absence of fourth ventricle patency and lateral dilatation of the fourth ventricular hemorrhage in CT findings are correlated with the outcome in spontaneous IVH.

Prognostic Effects of 4th Ventricular Hemorrhage in Intraventricular Hemorhage

Intraventricular hemorrhage(IVH) from any source is generally considered to be of grave prognostic significance. However, little is known about the prognostic effect of fourth IVH. The analysis of 65 patients with computerized tomography(CT)-documented fourth IVH treated between 1990 and 1994 is here in presented. The etiologies of the studied fourth IVH include hypertensive intracranial hemorrhage(39 cases), spontaneous subarachnoid hemorrhage(12 cases), primary IVH(9 cases), trauma(4 cases), Moyamoya disease(1 case). A 66.7% mortality rate was found in patients with a Glasgow coma scale(GCS) score of 3 to 5, 53.8% for those with a GCS score of 6 to 8, 28.6% for those patients with a GCS score of 9 to 12, and 9.5% for patients with a GCS score of 13 to 15. Admission status was significant outcome predictor(p<0.001). The mortality rate for patients with dilatation and fixed pupil was 64.7%. Pupillary reflex was also used as an outcome predictor(p<0.05). The mortality rate of patients with hemorrhagic dilatati on of the fourth ventricle was 70% while those with no hemorrhagic dilatation of the fourth ventricle was 28.9%. Hemorrhagic dilatation of the fourth ventricle was a potent predictor of outcome in fourth IVH(p<0.005). The mortality rate of patients with a ventriculocranial ratio(VCR) of 0.23 or more than 0.23, as calculated from initial CT scan, was 76.5% and those with a VCR of less than 0.16 was 26.7%. We have found that VCR is a potent prodictor of outcome in fourth IVH(p<0.005). The prognostic values of age, etiology of fourth IVH, lood pressure, the number of ventricle of hemorrhage presenting was found to be statistically insignificant. Patients with all ventricular hemorrhage and urokinase irrigation have a 64.5% mortality rate. Patients with fourth IVH and hemorrhagic dilatation of fourth ventricle, increased VCR, poor admission status, dilatation and fixed pupil are considered poor prognosis. Urokinase irrigation was the recommended management for these patients.