Prognostic Factors of Primary Intraventricular Hemorrhage.

Park, Kyung Jae; Kim, Joo Han; Park, Youn Kwan; Chung, Hung Seob; Lee, Hoon Gap; Suh, Jung Keun

Original Article

Journal of Korean Neurosurgical Society 2004;35(3): 278-283.

Kyung Jae Park, Joo Han Kim, Youn Kwan Park, Hung Seob Chung, Hoon Gap Lee, Jung Keun Suh

Department of Neurosurgery, College of Medicine, Korea University, Seoul, Korea. nskjh@kumc.or.kr

ABSTRACT

OBJECTIVE
Primary intraventricular hemorrhage(PIVH) is uncommon and accounts for only 3.1 % of all non-traumatic intracerebral hemorrhage. The aim of this study is to analyze clinical characteristics, image features, etiology and prognostic factors of outcome in patients with PIVH.
METHODS
We identified 25 patients with PIVH during 9-year period between 1994 and 2002 at our institute. The clinical data, complimentary examination, outcome and computed tomographic blood amounts were reviewed. RESULTS: Major symptoms included sudden decreased level of consciousness, headache, nausea/vomiting and neck stiffness. Cerebral angiography was performed in 12 patients(48%) and revealed vascular malformation in 6 patients(24%). The positive result of angiography was more common in young patients and among vascular malformation the incidence of Moyamoya disease was relatively high(4 patients). Other causative factors were coagulation disorder, arterial hypertension, tumor bleeding. Outcome were death in 9 patients(36%): 7 patients(28%) died by direct consequence of bleeding and 2 patients died after other adverse events(sepsis, hepatic failure) but prognosis of survivor was good. Factors correlating with the outcome were the presence of coagulopathy, initial Glasgow Coma Scale(GCS), obstruction of 4th ventricle and ventricular blood amount including hemorrhagic dilatation of temporal horn of lateral ventricle, 3rd and 4th ventricle. CONCLUSION: The poor prognosis factors of PIVH are the presence of coagulopathy, low initial GCS, obstruction of 4th ventricle and large ventricular blood amount. Additionally patients whose initial clinical condition is not serious need an appropriate work up including cerebral angiography, because cause of bleeding is vascular malformation especially in young patients.

Key Words: Primary intraventricular hemorrhage; Vascular malformation