Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage

Abstract

OBJECTIVE: To determine the prognostic significance and pathophysiologic implication of intraventricular extension of supratentorial intracerebral hemorrhage. DESIGN: Prospective study. SETTING: Acute stroke and neurointensive care units of a tertiary care hospital. PATIENTS: One hundred twenty-nine patients with supratentorial intracerebral hemorrhage, managed medically. INTERVENTIONS: Two patients had intraventricular catheters placed for external drainage. No patient received thrombolytics or surgical evacuation of clot. MEASUREMENTS AND MAIN RESULTS: Of the 129 patients, 47 had intraventricular extension of their hemorrhages. These patients had larger intraparenchymal hemorrhages (36.6 cm3 vs. 15.0 cm3) and lower initial Glasgow Coma Scale scores (mean, 9.6 vs. 13.7). Their 30-day mortality rate was 43% compared with only 9% among those without ventricular extension. Univariate and multivariate logistic regression modeling was used to assess the prognostic significance of various measures of intraventricular hemorrhage. The presence of intraventricular hemorrhage, the number of ventricles containing blood, fourth ventricular blood, and intraventricular hemorrhage volume were each related to 30-day mortality in a univariate analysis, but only intraventricular hemorrhage volume contributed significantly to outcome prediction in the presence of Glasgow Coma Scale score. CONCLUSIONS: Volume of intraventricular hemorrhage is an important determinant of outcome in supratentorial intracerebral hemorrhage.