Acta Neurochirurgica

, Volume 134, Issue 1–2, pp 55–59 | Cite as

Urokinase infusion for severe intraventricular haemorrhage

  • N. G. Rainov
  • W. L. Burkert
Special Case

Summary

The purpose of this study was to explore in patients with intraventricular haematomas the effectiveness and complication rate of a treatment protocol including standard ventriculostomy and application of urokinase via the catheter.

Our series includes 16 patients with severe CT-diagnosed intraparenchymal and predominantly intraventricular haemorrhages. In all cases, ventricular drainage was performed. Urokinase treatment was started immediately with intraventricular infusions of 10,000 U urokinase in 5 ml sterile physiological saline every 12 hours. Twelve patients had an excellent outcome, three good and one poor. There were no complications related to urokinase therapy. Side efects of the infusion volume were profuse sweating and headache which were present at 10 ml total infusion volume, but disappeared after reduction to 5 ml. A group of five patients with comparable lesions treated only with ventriculostomy served as controls. Two of them had a good outcome, two a poor one and one died. The late results in the urokinase-treated group were also favourable. Only one of the patients developed hydrocephalus and was shunted. In the control group, two patients required shunting for delayed hydrocephalus.

We conclude that this protocol for urokinase treatment is safe and effective and can be used in almost all patients with intracerebroventricular haemorrhage.

Keywords

Intraventricular haemorrhage urokinase ventriculostomy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Douglas MA, Haerer AF (1982) Long-term prognosis of hypertensive intracerebral haemorrhage. Stroke 13: 448–491PubMedGoogle Scholar
  2. 2.
    Fleischer AS, Huhn SL, Meislin H (1988) Post-traumatic acute obstructive hydrocephalus. Ann Emerg Med 17: 165–167PubMedGoogle Scholar
  3. 3.
    Graeb DA, Robertson WD, Lapointe JS, Nugent RA, Harrison PB (1982) Computed tomographic diagnosis of intraventricular haemorrhage. Radiology 143: 91–96PubMedGoogle Scholar
  4. 4.
    Hayashi M, Handa Y, Kobayashi H, Kawano H, Nozaki J, Hirose S (1988) Prognosis of intraventricular haemorrhage due to hypertensive haemorrhagic cerebrovascular disease. Zentralbl Neurochir 49: 101–108PubMedGoogle Scholar
  5. 5.
    Jayakumar PN, Taly AB, Bhavani UR, Arya BYT, Nagaraja D (1989) Prognosis in solitary intraventricular haemorrhage. Acta Neurol Scand 80: 1–5PubMedGoogle Scholar
  6. 6.
    Kim CH, Tanaka R, Kawakami K, Ito J (1981) Traumatic primary intraventricular haemorrhage. Surg Neurol 16: 415–417Google Scholar
  7. 7.
    Little JR, Blomquist GA, Ethier R (1977) Intraventricular haemorrhage in adults. Surg Neurol 8: 143–149PubMedGoogle Scholar
  8. 8.
    Matsumoto K, Hondo H (1984) CT-guided stereotactic evacuation of hypertensived intracerebral haematomas. J Neurosurg 61: 440–448PubMedGoogle Scholar
  9. 9.
    Nakajima S, Mizuno M, Sampei T, Suzuki A, Yasui N (1990) Intraventricular haematomas associated with hypertensive intracerebral haemorrhages: with special reference to third ventricular haematoma. No Shinkei Geka 18: 1107–1113PubMedGoogle Scholar
  10. 10.
    Narayan RK, Narayan TM, Katz DA, Kornblith PL, Murano G (1985) Lysis of intracranial haematomas with urokinase in a rabbit model. J Neurosurg 62: 580–586PubMedGoogle Scholar
  11. 11.
    Nath FP, Nicholls D, Fraser RJA (1983) Prognosis in intracerebral haemorrhage. Acta Neurochir (Wien) 67: 29–35Google Scholar
  12. 12.
    Ojemann RG, New PFJ (1963) Spontaneous resolution of an intraventricular haematoma. J Neurosurg 20: 899–902PubMedGoogle Scholar
  13. 13.
    Pia HW (1972) The surgical treatment of intracerebral and intraventricular haematomas. Acta Neurochir (Wien) 27: 149–164CrossRefGoogle Scholar
  14. 14.
    Portenoy RK, Lipton RB, Berger AR, Lesser ML, Lantos G (1987) Intracerebral haemorrhage: a model for the prediction of outcome. J Neurol Neurosurg Psychiatry 50: 976–979PubMedGoogle Scholar
  15. 15.
    Ruscalleda J, Peiro A (1986) Prognostic factors in intraparenchymatous haematoma with ventricular haemorrhage. Neuroradiology 28: 34–37PubMedGoogle Scholar
  16. 16.
    Shen PH, Matsuoka Y, Kawajiri K, Kanai M, Hoda K, Yamamoto S, Nishimura S (1990) Treatment of intraventricular haemorrhage using urokinase. Neurol Med Chir (Tokyo) 30: 329–333Google Scholar
  17. 17.
    Stalhammar D, Starmark J-E, Holmgren E, Erkisson N, Nordström CH, Fedders O, Rosander B (1988) Assessment of responsiveness in acute cerebral disorders. A multicentre study on the Reaction Level Scale (RLS 85). Acta Neurochir (Wien) 90: 73–80Google Scholar
  18. 18.
    Toto T, Usui M, Takakura K (1991) Treatment of severe intraventricular haemorrhage by intraventricular infusion of urokinase. J Neurosurg 1991: 81–86Google Scholar
  19. 19.
    Yagüte L, Garcia-March G, Paniagua C, Sanchez-Ledesma MJ, Diaz P, Ludena D, Maillo A, Broseta J (1987) Stereotactic evacuation and local administration in intracerebral haematomas. A comparative study. Acta Neurochir (Wien) [Suppl] 39: 45–48Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • N. G. Rainov
    • 1
  • W. L. Burkert
    • 1
  1. 1.Neurosurgical DepartmentMartin-Luther-UniversityHalleFederal Republic of Germany
  2. 2.Department of Molecular NeurogeneticsHarvard Medical School, Massachusetts General HospitalCharlestownUSA

Personalised recommendations