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Clinical Implications of Intraventricular Hemorrhage

Intracerebral hemorrhage volume was linked to presence of intraventricular hemorrhage in this retrospective study.

Intracerebral hemorrhage (ICH) is a devastating form of stroke. Several predictors of poor outcome have been identified, including intraventricular hemorrhage (IVH). In a cohort of 406 patients with ICH, these authors retrospectively examined the relation between location and volume of ICH and the presence of IVH. They also tested the hypothesis that IVH might actually be beneficial, if it provides spontaneous ICH decompression into the ventricle.

In addition to identifying ICH and IVH location and volume, the authors calculated a decompression range for each location of ICH; that is, the range of ICH volume below which IVH was rare and above which IVH was almost universal. The authors hypothesized that decompression into the ventricle may reduce parenchymal hemorrhage volume.

IVH was more common in patients with larger volumes of ICH and with ICH in certain brain regions. Patients with IVH were more likely to have poor outcomes. Spontaneous ventricular decompression (IVH and ICH volume in the lower half of the decompression range) was not associated with better outcomes compared with no spontaneous decompression (no IVH despite ICH volume in the upper half of the decompression range). The authors conclude that their results are consistent with prior studies that demonstrated the important prognostic value of IVH volume.

Comment: These findings suggest an association between IVH and ICH location and volume. Limitations of the study include its retrospective design and a failure to account for withdrawal of care as a potential confounder of poor outcome. In another recent study, restriction of the analysis to survivors showed that IVH was not predictive of functional outcome (Stroke 2008; 39:2304). In the present study, all patients with caudate ICH had IVH, but they had more-positive outcomes than those with ICH in other locations. Further prospective studies that account for withdrawal of care are needed to determine the role of IVH in outcome.

— Kevin Sheth, MD

Dr. Sheth is a Clinical Fellow in Neurology, Massachusetts General Hospital and Brigham and Women’s Hospital, Boston.

Published in Journal Watch Neurology September 9, 2008

Citation(s):

Hallevi H et al. Intraventricular hemorrhage: Anatomic relationships and clinical implications. Neurology 2008 Mar 11; 70:848.

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