Abstract
Background
The purpose of this study is to determine whether intraventricular hemorrhage (IVH) exerts a “decompressive” effect that limits intracerebral hemorrhage (ICH) enlargement.
Methods
Retrospective review of patients with spontaneous supratentorial ICH diagnosed within 6 h of onset, who underwent follow-up head CT approximately 48 h later. Digital imaging analysis of CT scans was performed to compare hematoma volume changes between patients with and without IVH. Hemorrhage locations were classified as paraventricular (PV) or non-PV. Regression analyses were employed to identify predictors of IVH, hematoma expansion, and mortality.
Results
Of the 70 patients included 57% developed IVH, 85% of which occurred before initial CT. 71% of PV hemorrhages developed IVH, all before initial CT, and 48% of non-PV hemorrhages developed IVH, 29% of which occurred after initial CT. IVH was associated with PV location (P = 0.04), and among IVH patients PV location was associated with early IVH (P = 0.003). Predictors of mortality included age (P = 0.037), initial hematoma volume (P < 0.04), absolute volume change (P = 0.01), and final hematoma volume (P < 0.001). Variables predicting IVH included PV location (P < 0.0001), larger initial hematoma volume (P = 0.002), and greater absolute volume increase (P = 0.01). Hematoma expansion was greatest for non-PV with IVH (P = 0.08), and graphic inspection suggested that ICH volume tended to decrease with PV location and increase with IVH. Final hematoma volume was associated with initial volume (P < 0.0001), non-PV location (P = 0.02), and IVH (P = 0.04).
Conclusions
IVH was not associated with less hematoma volume expansion, and for non-PV hemorrhages IVH was linked to greater volume increase.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Steiner T, Diringer M, Schneider D, et al. Dynamics of intraventricular hemorrhage in patients with spontaneous intracerebral hemorrhage—risk factors, clinical impact, and effect of hemostatic therapy with recombinant activated factor VII. Neurosurgery. 2006;59:767–74.
Hemphill J, Bonovich D, Besmertis L, Manley G, Johnston C. The ICH score—a simple and reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32:891–7.
Hallevi H, Albright K, Aronowski J, et al. Intraventricular hemorrhage—anatomic relationships and clinical implications. Neurology. 2008;70:848–52.
Mayer S, Brun N, Begtrup K, et al. Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Eng J Med. 2008;358:2127–37.
Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults. Stroke. 2001;38:2001–23.
Steiner T, Rosand J, Diringer M. Intracerebral hemorrhage associated with oral anticoagulant therapy—current practices and unresolved questions. Stroke. 2006;37:256–62.
Goldstein J, Thomas S, Frontiero V, et al. Timing of fresh frozen plasma administration and rapid correction of coagulopathy in warfarin related intracerebral hemorrhage. Stroke. 2006;37:151–5.
Broderick J, Diringer M, Hill M, et al. Determinants of intracerebral hemorrhage growth—an exploratory analysis. Stroke. 2007;38:1072–5.
Huttner H, Schellinger P, Hartmann M, et al. Hematoma growth and outcome in treated neurocritical care patients with intracerebral hemorrhage related to oral anticoagulant therapy. Stroke. 2006;37:1465–70.
Goldstein J, Fazen L, Snider R, et al. Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage. Neurology. 2007;68:889–94.
Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997;28:1–5.
Del Bigio M, Yan H-J, Buist R, Peeling J. Experimental intracerebral hemorrhage in rats. Stroke. 1996;27:2312–20.
Bowerman R, Donn S, Silver T, Jaffe M. Neonatal periventricular/intraventricular hemorrhage and its complications. AJR. 1984;143:1041–52.
Sacco S, Marini C, Toni D, Olivieri L, Carolei A. Incidence and 10-year survival of intracerebral hemorrhage in a population based registry. Stroke. 2009;40:394–9.
Davis S, Broderick J, Hennerici M, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006;66:1175–81.
Broderick J, Brott T, Duldner J, Tomsick T, Huster G. Volume of intracerebral hemorrhage—a powerful and easy to use predictor of 30-day mortality. Stroke. 1993;24:987–93.
Jauch E, Lindsell C, Adeoye O, et al. Lack of evidence for an association between hemodynamic variables and hematoma growth in spontaneous intracerebral hemorrhage. Stroke. 2006;37:2061–5.
Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) Investigators. Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med. 2010;38:637–48.
Sansing L, Messe S, Cucchiara B, Cohen S, Lyden P, Kasner S. Prior antiplatelet use does not affect hemorrhage growth or outcome after ICH. Neurology. 2009;72:1397–402.
Naidech A, Bernstein R, Levasseur K, et al. Platelet activity and outcome after intracerebral hemorrhage. Ann Neurol. 2009;65:352–6.
Freeman W, Barrett K, Bestic J, Meschia J, Broderick J, Brott T. Computer assisted volumetric analysis compared with ABC/2 method for assessing warfarin related intracranial hemorrhage volumes. Neurocrit Care. 2008;9:307–12.
Conflict of interest
The authors have no conflicts of interest or disclosures to announce.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Moussouttas, M., Malhotra, R., Fernandez, L. et al. Impact of Intraventricular Hemorrhage upon Intracerebral Hematoma Expansion. Neurocrit Care 14, 50–54 (2011). https://doi.org/10.1007/s12028-010-9452-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12028-010-9452-0