Intraventricular hemorrhage due to subarachnoid hemorrhage: Does the severity matter?

Intraventricular hemorrhage due to subarachnoid hemorrhage: Does the severity matter?

World Neurosurg. 2018 Jan 03;:

Authors: Oppong MD, Gembruch O, Herten A, Frantsev R, Chihi M, Dammann P, El Hindy N, Forsting M, Sure U, Jabbarli R

Abstract
OBJECT: Aneurysm rupture might be accompanied by intraventricular hemorrhage (IVH) that is associated with poor outcome of subarachnoid hemorrhage (SAH). The aim of this study was to analyze risk factors and clinical impact of IVH severity.
MATERIAL AND METHODS: 995 consecutive SAH patients treated at our institution between January 2003 and June 2016 were eligible for this study. Clinical and radiological findings were correlated with the presence and severity of IVH assessed with the original Graeb score.
RESULTS: Four hundred and eighty seven SAH patients (48.9%) presented with IVH (mean IVH severity: 5.48 points [± 3.5]). IVH severity correlated with poorer initial clinical condition (WFNS grade > 3, p < 0.001), acute hydrocephalus (p = 0.001) and poor outcome at 6 months (modified Rankin scale > 2, p < 0.001). Location of the ruptured aneurysm in anterior cerebral artery independently predicted the occurrence (p = 0.007) and severity of IVH (p < 0.001). In turn, aneurysm size impacted only the severity of IVH (p = 0.001), but not its occurrence (p = 0.153). Early complications of SAH occurring within 72 hours after the bleeding event: cerebral infarction (p = 0.043), early mortality (p = 0.001) and primary craniectomy (p = 0.043) were independently associated with the severity of IVH.
CONCLUSION: Severity of aneurysmal IVH is a strong contributor to initial severity and early complications of SAH. Patients with larger aneurysms, especially located in the anterior cerebral artery are at particular risk of severe IVH in case of aneurysm rupture.

PMID: 29305915 [PubMed - as supplied by publisher]

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