Abstract
This paper discusses the clinical aspects and prognosis of intraventricular hemorrhages with cerebrovascular diseases diagnosed by CT scan.
Intraventricular hemorrhage with cerebrovascular disease was identified in 81 cases and death occurred within seven days in 34 cases. Hypertension was the most common etiological factor, accounting for 40 of the 81 cases. Cerebral aneurysm was the second most common cause accounting for 27 cases, arteriovenous malformation accounted for 9 of the cases, and 5 were of other causes. The clinical signs analyzed on admission were the vital signs, consciousness level, ocular signs, motor function, and pathological reflexes. Signs of primary or secondary brain stem dysfunction were mainly seen in cases with hypertension and aneurysm, while cases with arteriovenous malformation had benign courses. The mortality depended on the severity of intraventricular hemorrhage; i.e., the distribution, site, and the number of cast formation. The presence of intraventricular clot in the third and/or fourth ventricles was correlated with a high mortality rate, especially in cases accompanied by cast formation and third and fourth ventricular dilatation, which affects hypothalamus and brain stem function. Analysis of CT findings for the mechanism of intraventricular hemorrhage revealed three types: extension type; in which massive intracerebral hematomas extended and ruptured into ventricles; the direct type, which bled directly into ventricles without forming definite intracerebral hematomas; and the reflux type, which was characterized by reflux of the subarachnoid blood.
Pathophysiology in the acute stage of intraventricular hemorrhage was closely related to increased intracranial pressure or intraventricular fluid pressure. Though ventricular drainage seemed to be of limited value, it would be the first therapeutic step to be performed for reducing intracranial pressure or intraventricular fluid pressure.
