Skip to main content

Advertisement

SpringerLink
Log in

Primary Intraventricular Hemorrhage: Yield of Diagnostic Angiography and Clinical Outcome

  • Original Paper
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  5. Passero S, Ulivelli M, Reale F. Primary intraventricular haemorrhage in adults. Acta Neurol Scand 2002;105:115–9.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  9. Verma A, Maheshwari MC, Bhargava S. Spontaneous intraventricular haemorrhage. J Neurol 1987;234:233–6.

    Article  PubMed  CAS  Google Scholar 

  10. Kiymaz N, Demir O, Cirak B. Is external ventricular drainage useful in primary intraventricular hemorrhages? Adv Ther 2005;22:447–52.

    Article  PubMed  Google Scholar 

  11. Ara JR, Martin J, Errea JM, Bertol V, Pina MA, Oliveros A. Primary intraventricular hemorrhage in the adult. Neurologia 1991;6:13–6.

    PubMed  CAS  Google Scholar 

  12. Tembl J, Lago A, Baquero M, Blasco R. Primary intraventricular hemorrhage: an analysis of eight cases. Rev Neurol 1997;25:215–8.

    PubMed  CAS  Google Scholar 

  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. 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. Bilinska M, Swierkocka-Miastkowska M, Dobrzynska L. Primary and secondary intraventricular hemorrhage–clinical analysis. Neurol Neurochir Pol 1999;32(Suppl 6):141–7.

    PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  25. Taheri SA, Wani MA, Lewko J. Intraventricular hemorrhage due to rupture of arteriovenous malformations. Zentralbl Neurochir 1990;51:201–5.

    PubMed  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    CAS  Google Scholar 

  28. Irie F, Fujimoto S, Uda K, et al. Primary intraventricular hemorrhage from dural arteriovenous fistula. J Neurol Sci 2003;215:115–8.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  31. Naff NJ. Intraventricular hemorrhage in adults. Curr Treat Options Neurol 1999;1:173–8.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  33. Rajendra T, Kumar K, Liang LH. Hypertensive primary intraventricular hemorrhage due to a phaeochromocytoma. ANZ J Surg 2006;76:664–7.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

Download references

Acknowledgments

V.S. was supported by PHS K23 NS42072.

Author information

Authors and Affiliations

  1. Department of Neuroscience, Kaiser Permanente, Redwood City, 1150 Veterans Blvd, Redwood City, CA, 94063, USA

    Alexander C. Flint

  2. University of California, Davis, Davis, USA

    Ashley Roebken

  3. Department of Neurology, Neurovascular and Neurocritical Care Service, University of California, San Francisco, San Francisco, USA

    Vineeta Singh

Authors
  1. Alexander C. Flint
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashley Roebken
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vineeta Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander C. Flint.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM1 (DOC 67 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Flint, A.C., Roebken, A. & Singh, V. Primary Intraventricular Hemorrhage: Yield of Diagnostic Angiography and Clinical Outcome. Neurocrit Care 8, 330–336 (2008). https://doi.org/10.1007/s12028-008-9070-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-008-9070-2

Keywords

Search

Navigation