Intraventricular Hemorrhage: Presentation and Management Options

Intraventricular hemorrhage (IVH) as a primary event or as a complication of intracerebral hemorrhage (ICH) carries a poor prognosis. The effects of IVH on brain function are mediated via complicating hydrocephalus (with increased intracranial pressure and decreased cerebral perfusion pressure), presence of blood clots in the ventricular system, and carrying of blood degradation products into the CSF pathways, all of which contribute to morbidity and mortality. The management of IVH has been traditionally based on draining the blood from the ventricular system (and reducing hydrocephalus) via external ventricular drainage techniques. Their inadequate results (due to frequent obstruction of the draining system by clot) and tendency to complications (mainly infection) has led to the search of alternative treatments. A promosing approach has been the addition of intraventricular instillation of thrombolytics to the external ventricular drainage, in an attempt at accelerating blood clot lysis and removal. This approach has shown initial encouraging results, with adequate drainage of intraventricular clots without an increase in intracranial bleeding. The procedure is currently being tested in a prospective randomized clinical trial.