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Intraventricular hemorrhage
Classification and external resources

CT scan showing spontaneous intracerebral hemorrhage with bleeding in the third and both lateral ventricles and hydrocephalus[1]
ICD-10 I61.5
ICD-9 431
DiseasesDB 6906
eMedicine ped/2595

An intraventricular hemorrhage (or intraventricular haemorrhage in British English), often abbreviated "IVH," is a bleeding into the brain's ventricular system, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. It can result from physical trauma or from hemorrhaging in stroke.

Contents

In infants

This type of hemorrhage is particularly common in infants, especially premature infants or those of very low birth weight.[2] The cause of IVH in premature infants, unlike that in older infants, children or adults, is rarely due to trauma. Instead it is thought to result from changes in perfusion of the delicate cellular structures that are present in the growing brain, augmented by the immaturity of the cerebral circulatory system, which is especially vulnerable to hypoxic ischemic encephalopathy. The lack of blood flow results in cell death and subsequent breakdown of the blood vessel walls, leading to bleeding. While this bleeding can result in further injury, it is itself a marker for injury that has already occurred. Most intraventricular hemorrhages occur in the first 72 hours after birth.[2]

The amount of bleeding varies. IVH is often described in four grades:

Grade I - bleeding occurs just in the germinal matrix. Grade II - bleeding also occurs inside the ventricles. Grade III - ventricles are enlarged by the blood. Grade IV - there is bleeding into the brain tissues around the ventricles.

Grades I and II are most common, and often there are no further complications. Grades III and IV are the most serious and may result in long-term brain injury to the infant. After a grade III or IV IVH, blood clots may form which can block the flow of cerebrospinal fluid, leading to increased fluid in the brain (hydrocephalus).

In adults

Intraventricular hemorrhage has been found to occur in 35% of moderate to severe traumatic brain injuries.[3] The injury requires a great deal of force to cause. Thus the hemorrhage usually does not occur without extensive associated damage, and so the outcome is rarely good.[4][5]

Prognosis is also dismal when IVH results from intracerebral hemorrhage related to high blood pressure and is even worse when hydrocephalus follows.[1] It can result in dangerous increases in intracranial pressure and can cause potentially fatal brain herniation.[1]

Associated conditions

Brain contusions and subarachnoid hemorrhages are commonly associated with IVH.[6] The bleeding can involve the middle communicating artery or the posterior communicating artery.

In both adults and infants, IVH can cause dangerous increases in intracranial pressure, damage to the brain tissue, and hydrocephalus.[2][7]

References

  1. ^ a b c Yadav YR, Mukerji G, Shenoy R, Basoor A, Jain G, Nelson A (2007). "Endoscopic management of hypertensive intraventricular haemorrhage with obstructive hydrocephalus". BMC Neurol 7: 1. doi:10.1186/1471-2377-7-1. PMID 17204141. PMC 1780056. http://www.biomedcentral.com/1471-2377/7/1.  
  2. ^ a b c Annibale DJ and Hill J. 2006. Periventricular Hemorrhage-Intraventricular Hemorrhage. Emedicine.com. Retrieved on June 19, 2007.
  3. ^ Barkley JM, Morales D, Hayman LA, Diaz-Marchan PJ (2006). "Static neuroimaging in the evaluation of TBI". in Zasler ND, Katz DI, Zafonte RD. Brain Injury Medicine: Principles and Practice. Demos Medical Publishing. pp. 140–43. ISBN 1-888799-93-5. http://books.google.com/books?id=yplFkKimNcYC&pg=PA134&lpg=PA134&dq=define+Intra-axial+hematoma&source=web&ots=9XsNbubP_E&sig=-BW93XfLYNx8YuNVg3HE3QqT4tg&hl=en&sa=X&oi=book_result&resnum=10&ct=result#PPA140,M1.  
  4. ^ Dawodu S. 2007. "Traumatic Brain Injury: Definition, Epidemiology, Pathophysiology" Emedicine.com. Retrieved on June 19, 2007.
  5. ^ Vinas FC and Pilitsis J. 2006. "Penetrating Head Trauma." Emedicine.com.
  6. ^ LeRoux PD, Haglund MM, Newell DW, Grady MS, and Winn HR. 1992. "Intraventricular hemorrhage in blunt head trauma: an analysis of 43 cases." Neurosurgery. Volume 4, pp. 678-84. PMID 1407453. Retrieved on June 19, 2007.
  7. ^ Mayfrank L, Kissler J, Raoofi R, Delsing P, Weis J, Kuker W, and Gilsbach JM. 1997. Ventricular Dilatation in Experimental Intraventricular Hemorrhage in Pigs: Characterization of Cerebrospinal Fluid Dynamics and the Effects of Fibrinolytic Treatment. Stroke, 28:141–148. Retrieved on June 19, 2007.

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