Intraventricular hemorrhage

Introduction Intraventricular hemorrhage (IVH) occurs as a primary diagnosis and most commonly secondary to subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH). In the setting of spontaneous ICH, intraventricular extension of hemorrhage (i.e., IVH) is a poor prognostic sign, with an expected mortality between 50% and 80%, although primary IVH represents a distinct entity with a better prognosis [1–3]. This chapter discusses epidemiology, clinical presentation, neuroimaging, grading scales, and prognostication for primary and secondary IVH. Epidemiology Between 25% and 45% of aneurysmal SAH and approximately 45% of spontaneous ICH extend into the ventricles, while only 1.5%–3% of patients with blunt head trauma and 10% of patients with severe head injury have intraventricular blood [1,4]. Intraventricular hemorrhage contributes significantly to morbidity and mortality in ICH, SAH, and traumatic brain injury (TBI) [5–9]. Factors that predispose to IVH in association with ICH include older age, higher baseline ICH volume, mean arterial pressure (MAP) values greater than 120 mmHg, and deep subcortical location of primary ICH in close proximity to the ventricles [3]. Intraventricular hemorrhage associated with SAH is more often found in patients with premorbid cardiovascular risk factors (hypertension, diabetes, and coronary artery disease), worse neurological grade on admission, higher blood pressure, thicker and more diffuse SAH, ICH, posterior circulation aneurysm, and vasospasm on admission angiography compared to SAH patients without IVH [4]. Severity of IVH is an independent predictor of death and functional outcome in SAH patients.