Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial

  • P. S. Bhattathiri
  • B. Gregson
  • K. S. M. Prasad
  • A. D. Mendelow
Part of the Acta Neurochirurgica Supplementum book series (NEUROCHIRURGICA, volume 96)

Summary

Introduction

Intraventricular hemorrhage (IVH), either independent of or as an extension of intracranial bleed, is thought to carry a grave prognosis. Although the effect of IVH on outcome in patients with subarachnoid hemorrhage has been extensively reviewed in the literature, reports of spontaneous intracerebral hemorrhage (ICH) in similar situations have been infrequent. The association of hydrocephalus in such situations and its influence on outcome is also uncertain.

Patients and methods

As a sub-analysis of data obtained through the international Surgical Trial in Intracerebral Hemorrhage (STICH), the impact of IVH, with or without the presence of hydrocephalus, on outcome in patients with spontaneous ICH was analyzed. CT scans of randomized patients were examined for IVH and/or hydrocephalus. Other characteristics of hematoma were evaluated to see if they influenced outcome, as defined by the STICH protocol [9].

Results

Favorable outcomes were more frequent when IVH was absent (31.4% vs. 15.1%; p < 0.00001). The presence of hydrocephalus lowered the likelihood of favorable outcome still further to 11.5% (p = 0.031). In patients with IVH, early surgical intervention had a more favorable outcome (17.8%) compared to initial conservative management (12.4%) (p = 0.141).

Conclusion

The presence of IVH and hydrocephalus are independent predictors of poor outcome in spontaneous ICH. Early surgery is of some benefit in those with IVH.

Keywords

Intracerebral hemorrhage intraventricular hemorrhage hydrocephalus outcome 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bhattathiri PS, Gregson B, Prasad KS, Mitchell P, Soh C, Mitra D, Gholkar A, Mendelow AD (2003) Reliability assessment of computerized tomography scanning measurements in intracerebral hematoma. Neurosurg Focus 15: E6PubMedCrossRefGoogle Scholar
  2. 2.
    Diamond P, Gale S, Stewart K (2003) Primary intracerebral haemorrhage — clinical and radiologic predictors of survival and functional outcome. Disabil Rehabil 25: 689–698PubMedCrossRefGoogle Scholar
  3. 3.
    Findlay JM, Jacka MJ (2004) Cohort study of intraventricular thrombolysis with recombinant tissue plasminogen activator for aneurysmal intraventricular hemorrhage. Neurosurgery 55: 532–538PubMedCrossRefGoogle Scholar
  4. 4.
    Franz G, Brenneis C, Kampfl A, Pfausler B, Poewe W, Schmutzhard E (2001) Prognostic value of intraventricular blood in perimesencephalic nonaneurysmal subarachnoid hemorrhage. J Comput Assist Tomogr 25: 742–746PubMedCrossRefGoogle Scholar
  5. 5.
    Kumar R, Pathak A, Mathuriya SN, Khandelwal N (2003) Intraventricular sodium nitroprusside therapy: a future promise for refractory subarachnoid hemorrhage-induced vasospasm. Neurol India 51: 197–202PubMedGoogle Scholar
  6. 6.
    Lapointe M, Haines S (2002) Fibrinolytic therapy for intraventricular hemorrhage in adults. Cochrane Database Syst Rev: CD003692Google Scholar
  7. 7.
    Mayfrank L, Kim Y, Kissler J, Delsing P, Gilsbach JM, Schroder JM, Weis J (2000) Morphological changes following experimental intraventricular haemorrhage and intraventricular fibrinolytic treatment with recombinant tissue plasminogen activator. Acta Neuropathol (Berl) 100: 561–567PubMedCrossRefGoogle Scholar
  8. 8.
    Mayfrank L, Hutter BO, Kohorst Y, Kreitschmann-Andermahr I, Rohde V, Thron A, Gilsbach JM (2001) Influence of intraventricular hemorrhage on outcome after rupture of intracranial aneurysm. Neurosurg Rev 24: 185–191PubMedCrossRefGoogle Scholar
  9. 9.
    Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, Karimi A, Shaw MD, Barer DH; STICH investigatos (2005) Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet 365: 387–397PubMedGoogle Scholar
  10. 10.
    Naff NJ (1999) Intraventricular Hemorrhage in Adults. Curr Treat Options Neurol 1: 173–178PubMedGoogle Scholar
  11. 11.
    Naff NJ, Hanley DF, Keyl PM, Tuhrim S, Kraut M, Bederson J, Bullock R, Mayer SA, Schmutzhard E (2004) Intraventricular thrombolysis speeds blood clot resolution: results of a pilot, prospective, randomized, double-blind, controlled trial. Neurosurgery 54: 577–584PubMedCrossRefGoogle Scholar
  12. 12.
    Nakagawa T, Suga S, Mayanagi K, Akaji K, Inamasu J, Kawase T; Keio SAH Cooperative Study Group (2005) Predicting the overall management outcome in patients with a subarachnoid hemorrhage accompanied by a massive intracerebral or full-packed intraventricular hemorrhage: a 15-year retrospective study. Surg Neurol 63: 329–335PubMedCrossRefGoogle Scholar
  13. 13.
    Nieuwkamp DJ, de Gans K, Rinkel GJ, Algra A (2000) Treatment and outcome of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage: a systematic review of the literature. J Neurol 247: 117–121PubMedCrossRefGoogle Scholar
  14. 14.
    Passero S, Ulivelli M, Reale F (2002) Primary intraventricular haemorrhage in adults. Acta Neurol Scand 105: 115–119PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • P. S. Bhattathiri
    • 2
  • B. Gregson
    • 2
  • K. S. M. Prasad
    • 2
  • A. D. Mendelow
    • 2
    • 1
  1. 1.Department of NeurosurgeryNewcastle General HospitalNewcastle Upon TyneUK
  2. 2.Regional Neurosciences CentreNewcastle General HospitalNewcastle Upon TyneUK

Personalised recommendations