Neurocritical Care

, Volume 8, Issue 3, pp 330–336 | Cite as

Primary Intraventricular Hemorrhage: Yield of Diagnostic Angiography and Clinical Outcome

  • Alexander C. FlintEmail author
  • Ashley Roebken
  • Vineeta Singh
Original Paper



Primary intraventricular hemorrhage (IVH), bleeding in the ventricular system without a discernable parenchymal component, is a rare neurological disorder. To better define the features of primary IVH and the yield of diagnostic angiography in this condition, we retrospectively analyzed all cases of primary IVH evaluated at a tertiary referral hospital over a 6-year period and performed a systematic review of the literature.


For the retrospective case series, all patients with primary IVH admitted to the neurovascular service at a single tertiary referral center over a 6-year period were identified by screening a departmental database. For the systematic review of the literature, all case series of patients with primary IVH diagnosed by computed tomography were identified in the Medline database.


From the systematic review, the majority of patients with spontaneous primary IVH presented with headache (69%), nausea/vomiting (53%), and altered mental status (66%). Most primary IVH patients had associated hydrocephalus (62%), and about one-third required ventricular drainage (34%). Diagnostic cerebral angiography was positive for a bleeding source in 56%. The two most common causes identified by angiography were arteriovenous malformations (58% of positive angiograms) and aneurysms (36% of positive angiograms). Approximately one-third of patients with primary IVH do not survive hospital discharge (39%). Patient age and amount of IVH independently predicted in-hospital mortality.


Primary IVH is a rare form of intracerebral hemorrhage, with varying short-term outcomes that depend on patient age and the extent of intraventricular hemorrhage. The yield of diagnostic cerebral angiography in the setting of primary IVH is very high. The two most common causes of primary IVH identified on angiography are arteriovenous malformations and aneurysms. Routine catheter angiography in the setting of primary IVH is warranted.


Intraventricular hemorrhage Cerebral angiography Intracerebral hemorrhage Hydrocephalus Computed tomography 



V.S. was supported by PHS K23 NS42072.

Supplementary material

12028_2008_9070_MOESM1_ESM.doc (68 kb)
ESM1 (DOC 67 kb)


  1. 1.
    Graeb DA, Robertson WD, Lapointe JS, Nugent RA, Harrison PB. Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis. Radiology 1982;143:91–6.PubMedGoogle Scholar
  2. 2.
    Hameed B, Khealani BA, Mozzafar T, Wasay M. Prognostic indicators in patients with primary intraventricular haemorrhage. J Pak Med Assoc 2005;55:315–7.PubMedGoogle Scholar
  3. 3.
    Angelopoulos M, Gupta SR, Azat Kia B. Primary intraventricular hemorrhage in adults: clinical features, risk factors, and outcome. Surg Neurol 1995;44:433–6; discussion 437.PubMedCrossRefGoogle Scholar
  4. 4.
    Marti-Fabregas J, Piles S, Guardia E, Marti-Vilalta JL. Spontaneous primary intraventricular hemorrhage: clinical data, etiology and outcome. J Neurol 1999;246:287–91.PubMedCrossRefGoogle Scholar
  5. 5.
    Passero S, Ulivelli M, Reale F. Primary intraventricular haemorrhage in adults. Acta Neurol Scand 2002;105:115–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Darby DG, Donnan GA, Saling MA, Walsh KW, Bladin PF. Primary intraventricular hemorrhage: clinical and neuropsychological findings in a prospective stroke series. Neurology 1988;38:68–75.PubMedGoogle Scholar
  7. 7.
    Jayakumar PN, Taly AB, Bhavani UR, Arya BY, Nagaraja D. Prognosis in solitary intraventricular haemorrhage. Clinical and computed tomographic observations. Acta Neurol Scand 1989;80:1–5.PubMedGoogle Scholar
  8. 8.
    Roos YB, Hasan D, Vermeulen M. Outcome in patients with large intraventricular haemorrhages: a volumetric study. J Neurol Neurosurg Psychiatry 1995;58:622–4.PubMedGoogle Scholar
  9. 9.
    Verma A, Maheshwari MC, Bhargava S. Spontaneous intraventricular haemorrhage. J Neurol 1987;234:233–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Kiymaz N, Demir O, Cirak B. Is external ventricular drainage useful in primary intraventricular hemorrhages? Adv Ther 2005;22:447–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Ara JR, Martin J, Errea JM, Bertol V, Pina MA, Oliveros A. Primary intraventricular hemorrhage in the adult. Neurologia 1991;6:13–6.PubMedGoogle Scholar
  12. 12.
    Tembl J, Lago A, Baquero M, Blasco R. Primary intraventricular hemorrhage: an analysis of eight cases. Rev Neurol 1997;25:215–8.PubMedGoogle Scholar
  13. 13.
    Cho Y, Whang K, Pyen J, Hu C, Hong S, Kim H. Prognostic factors in spontaneous primary intraventricular hemorrhage. J Korean Neurosurg Soc 2004;35:297–301.Google Scholar
  14. 14.
    Park K, Kim J, Park Y, Chung H, Lee H, Suh J. Prognostic factors of primary intraventricular hemorrhage. J Korean Neurosurg Soc 2004;35:278–83.Google Scholar
  15. 15.
    Bilinska M, Swierkocka-Miastkowska M, Dobrzynska L. Primary and secondary intraventricular hemorrhage–clinical analysis. Neurol Neurochir Pol 1999;32(Suppl 6):141–7.PubMedGoogle Scholar
  16. 16.
    Halpin SF, Britton JA, Byrne JV, Clifton A, Hart G, Moore A. Prospective evaluation of cerebral angiography and computed tomography in cerebral haematoma. J Neurol Neurosurg Psychiatry 1994;57:1180–6.PubMedGoogle Scholar
  17. 17.
    Zhu XL, Chan MS, Poon WS. Spontaneous intracranial hemorrhage: which patients need diagnostic cerebral angiography? A prospective study of 206 cases and review of the literature. Stroke 1997;28:1406–9.PubMedGoogle Scholar
  18. 18.
    Murakami M, Takahashi A, Murakami T, Endo H, Saiki I, Kanaya H. A case of isolated fourth ventricle due to ruptured cerebral aneurysm. No Shinkei Geka 1986;14:817–21.PubMedGoogle Scholar
  19. 19.
    Sadato N, Numaguchi Y, Rigamonti D, Salcman M, Gellad FE, Kishikawa T. Bleeding patterns in ruptured posterior fossa aneurysms: a CT study. J Comput Assist Tomogr 1991;15:612–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Yeh HS, Tomsick TA, Tew JM Jr. Intraventricular hemorrhage due to aneurysms of the distal posterior inferior cerebellar artery. Report of three cases. J Neurosurg 1985;62:772–5.PubMedGoogle Scholar
  21. 21.
    Anegawa S, Hayashi T, Torigoe R, Higashioka H, Tomokiyo M, Ogasawara T. Choroidal artery aneurysms of the posterior inferior cerebellar artery presented with fourth ventricular hemorrhage: report of 2 cases. No Shinkei Geka 1998;26:729–35.PubMedGoogle Scholar
  22. 22.
    Lagares A, Putman CM, Ogilvy CS. Posterior fossa decompression and clot evacuation for fourth ventricle hemorrhage after aneurysmal rupture: case report. Neurosurgery 2001;49:208–11.PubMedCrossRefGoogle Scholar
  23. 23.
    Irikura T, Sakai H, Nakahara S, Hasegawa Y. Isolated intraventricular hemorrhage due to a ruptured vertebral artery aneurysm. No Shinkei Geka 1990;18:469–73.PubMedGoogle Scholar
  24. 24.
    Griffiths SJ, Sgouros S, James G, John P. Intraventricular haemorrhage due to ruptured posterior inferior cerebellar artery aneurysm in tuberculous meningitis. Childs Nerv Syst 2000;16:872–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Taheri SA, Wani MA, Lewko J. Intraventricular hemorrhage due to rupture of arteriovenous malformations. Zentralbl Neurochir 1990;51:201–5.PubMedGoogle Scholar
  26. 26.
    Nagata S, Matsushima T, Fujii K, Takeshita I, Fukui M, Yasumori K. Lateral ventricular arteriovenous malformations: natural history and surgical indications. Acta Neurochir (Wien) 1991;112:37–46.CrossRefGoogle Scholar
  27. 27.
    Wang YC, Lee SD, Chen NF, Shen CC. Cerebral intraventricular hemorrhage caused by a large cerebral arteriovenous malformation at 31 years after diagnosis. Zhonghua Yi Xue Za Zhi (Taipei) 2001;64:121–8.Google Scholar
  28. 28.
    Irie F, Fujimoto S, Uda K, et al. Primary intraventricular hemorrhage from dural arteriovenous fistula. J Neurol Sci 2003;215:115–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Irikura K, Miyasaka Y, Kurata A, et al. A source of haemorrhage in adult patients with moyamoya disease: the significance of tributaries from the choroidal artery. Acta Neurochir (Wien) 1996;138:1282–6.CrossRefGoogle Scholar
  30. 30.
    Kawaguchi S, Sakaki T, Kakizaki T, Kamada K, Shimomura T, Iwanaga H. Clinical features of the haemorrhage type moyamoya disease based on 31 cases. Acta Neurochir (Wien) 1996;138:1200–10.CrossRefGoogle Scholar
  31. 31.
    Naff NJ. Intraventricular hemorrhage in adults. Curr Treat Options Neurol 1999;1:173–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Sanders E. A study of primary, immediate, or direct hemorrhage into the ventricles of the brain. Am J Med Sci 1881;82:85–128.CrossRefGoogle Scholar
  33. 33.
    Rajendra T, Kumar K, Liang LH. Hypertensive primary intraventricular hemorrhage due to a phaeochromocytoma. ANZ J Surg 2006;76:664–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Atzema C, Mower WR, Hoffman JR, Holmes JF, Killian AJ, Wolfson AB. Prevalence and prognosis of traumatic intraventricular hemorrhage in patients with blunt head trauma. J Trauma 2006;60:1010–7; discussion 1017.PubMedGoogle Scholar

Copyright information

© Humana Press Inc. 2008

Authors and Affiliations

  • Alexander C. Flint
    • 1
    Email author
  • Ashley Roebken
    • 2
  • Vineeta Singh
    • 3
  1. 1.Department of NeuroscienceKaiser Permanente, Redwood CityRedwood CityUSA
  2. 2.University of California, DavisDavisUSA
  3. 3.Department of Neurology, Neurovascular and Neurocritical Care ServiceUniversity of California, San FranciscoSan FranciscoUSA

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