Adult Primary Intraventricular Hemorrhage: Clinical Characteristics and Outcomes

Abstract

Background Adult primary intraventricular hemorrhage (PIVH) is a rare type of hemorrhagic stroke that is poorly understood. The study attempts to define the clinical profile, yield of diagnostic cerebral angiography, and prognosis of patients with PIVH. Patients and Methods Retrospective data analysis of all patients with PIVH admitted between February 2015 and February 2019 at a tertiary care center. Outcome was assessed using the modified Rankin scale (mRS) at 6 months. Results and Discussion Our study group of 30 patients constituted 3.3% (30/905) of our spontaneous intracerebral hemorrhage (SICH) patients in the study period. The mean Glasgow Coma Score on admission was 11 ± 3.33 and the mean IVH Graeb score was 5.2±2.4. All patients underwent angiography. Angiography detected moyamoya disease in four patients (13.3%) and aneurysms in two patients (6.6%) and these patients were managed surgically. Extraventricular drainage with intraventricular instillation of Streptokinase was performed in five patients. The rest of the patients was managed conservatively. At 6-month follow-up, 25 patients (83.33%) achieved favorable outcome (mRS score of 0.1 or 2), whereas five (16.66%) patients had a poor outcome (mRS score of 3 or more. Three patients succumbed to the illness. IVH Graeb score and presence of hydrocephalus have significant correlation with poor outcome. Conclusion PIVH is an uncommon entity but carries a better long-term prognosis than SICH angiography helps in diagnosing surgically remediable underlying vascular anomalies and is indicated in all cases of PIVH.

Keywords: Graeb score; cerebral angiography; hydrocephalus; intracerebral hemorrhage; intraventricular hemorrhage.

Fig. 1

Computed tomography scan plain axial image ( A ) showing intraventricular hemorrhage in the lateral ventricle. Digital subtraction angiography images of left internal carotid artery—lateral ( B ), oblique ( C ), and anteroposterior ( D ) showing presence of moyamoya vessels and complete obliteration of the supraclinoid internal carotid artery.

Fig. 2

Computed tomography scan plain sagittal ( A ) and axial ( B ) images showing presence of blood in the third ventricle and the fourth ventricle. Digital subtraction images vertebral artery anteroposterior ( C ) and lateral ( D ) showing the presence of a posterior inferior cerebellar artery aneurysm.