Intraventricular hemorrhage - Wikipedia

Intraventricular hemorrhage (IVH), also known as intraventricular bleeding, is a bleeding into the brain's ventricular system, where the cerebrospinal fluid ... Intraventricularhemorrhage FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch MedicalconditionIntraventricularhemorrhageOthernamesintraventricularhaemorrhage,intraventricularbleedingCTscanshowingspontaneousintracerebralhemorrhagewithbleedinginthethirdandbothlateralventriclesandhydrocephalus[1]SpecialtyNeurology  Intraventricularhemorrhage(IVH),alsoknownasintraventricularbleeding,isableedingintothebrain'sventricularsystem,wherethecerebrospinalfluidisproducedandcirculatesthroughtowardsthesubarachnoidspace.Itcanresultfromphysicaltraumaorfromhemorrhagicstroke. 30%ofintraventricularhemorrhage(IVH)areprimary,confinedtotheventricularsystemandtypicallycausedbyintraventriculartrauma,aneurysm,vascularmalformations,ortumors,particularlyofthechoroidplexus.[2]However70%ofIVHaresecondaryinnature,resultingfromanexpansionofanexistingintraparenchymalorsubarachnoidhemorrhage.[2]Intraventricularhemorrhagehasbeenfoundtooccurin35%ofmoderatetoseveretraumaticbraininjuries.[3]Thusthehemorrhageusuallydoesnotoccurwithoutextensiveassociateddamage,andsotheoutcomeisrarelygood.[4][5] Contents 1Symptoms 1.1Adults 1.2Infants 2Causes 2.1Adults 2.2Infants 3Mechanism 4Diagnosis 4.1Infants 5Prevention 6Treatment 6.1Infants 7Prognosis 7.1Associatedconditions 8Epidemiology 9Research 10References 11Externallinks Symptoms[edit] Adults[edit] SymptomsofIVHaresimilartootherintracerebralhemorrhagesandincludesuddenonsetofheadache,nauseaandvomiting,togetherwithanalteration ofthementalstateand/orlevelofconsciousness.[6]Focalneurologicalsignsareeitherminimalorabsent,butfocaland/orgeneralizedseizuresmayoccur.[6]Xanthochromia,yellow-tingedCSF,istherule.[6] Infants[edit] Someinfantsareasymptomaticandothersmaypresentwithhardtodetectabnormalitiesofconsciousness,muscletone,breathing,movementsoftheireyes,andbodymovements.[7] Causes[edit] Adults[edit] CausesofIVHinadultsincludephysicaltraumaorfromhemorrhagicstroke.[2] Infants[edit] Infantsthatarepretermandverylowbirthweightarealsoathighrisk.[8]IVHinthepretermbrainusuallyarisesfromthegerminalmatrixwhereasIVHintheterminfantsoriginatesfromthechoroidplexus.However,itisparticularlycommoninprematureinfantsorthoseofverylowbirthweight.[9]ThecauseofIVHinprematureinfants,unlikethatinolderinfants,childrenoradults,israrelyduetotrauma.Insteaditisthoughttoresultfromchangesinperfusionofthedelicatecellularstructuresthatarepresentinthegrowingbrain,augmentedbytheimmaturityofthecerebralcirculatorysystem,whichisespeciallyvulnerabletohypoxicischemicencephalopathy.Thelackofbloodflowresultsincelldeathandsubsequentbreakdownofthebloodvesselwalls,leadingtobleeding.Whilethisbleedingcanresultinfurtherinjury,itisitselfamarkerforinjurythathasalreadyoccurred.Mostintraventricularhemorrhagesoccurinthefirst72hoursafterbirth.[9]Theriskisincreasedwithuseofextracorporealmembraneoxygenationinpreterminfants.[10]Congenitalcytomegalovirusinfectioncanbeanimportantcause.[11] Mechanism[edit] Diagnosis[edit] DiagnosiscanbeconfirmedbythepresenceofbloodinsidetheventriclesonCT.[7] Infants[edit] IntermandpreterminfantswithIVH,theamountofbleedingvaries.IVHisoftendescribedinfourgrades:[citationneeded] GradeI-bleedingoccursjustinthegerminalmatrix GradeII-bleedingalsooccursinsidetheventricles,buttheyarenotenlarged GradeIII-ventriclesareenlargedbytheaccumulatedblood GradeIV-bleedingextendsintothebraintissuearoundtheventricles GradesIandIIaremostcommon,andoftentherearenofurthercomplications.GradesIIIandIVarethemostseriousandmayresultinlong-termbraininjurytotheinfant.AfteragradeIIIorIVIVH,bloodclotsmayformwhichcanblocktheflowofcerebrospinalfluid,leadingtoincreasedfluidinthebrain(hydrocephalus). Prevention[edit] Headpositioninginverypreterminfantshasbeensuggestedasanapproachtopreventgerminalmatrixhaemorrhage;however,furtherresearchisrequiredtodeterminetheeffectivenessatreducingmortalityandthemostappropriatepositioningtechnique.[12]Approachesincludebedtilting,supinemid-lineheadpositioning,supineheadrotation90degrees,pronemid-lineheadpositioning,headtiling.[12] Treatment[edit] TreatmentfocusesonmonitoringandshouldbeaccomplishedwithinpatientfloorserviceforindividualsresponsivetocommandsorneurologicalICUobservationforthosewithimpairedlevelsofconsciousness.[13]Extraattentionshouldbeplacedonintracranialpressure(ICP)monitoringviaanintraventricularcatheterandmedicationstomaintainICP,bloodpressure,andcoagulation.[2]InmoreseverecasesanexternalventriculardrainmayberequiredtomaintainICPandevacuatethehemorrhage,andinextremecasesanopencraniotomymayberequired.[2][13]IncasesofunilateralIVHwithsmallintraparenchymalhemorrhagethecombinedmethodofstereotaxyandopencraniotomyhasproducedpromisingresults.[14] Infants[edit] Therehavebeenvarioustherapiesemployedintopreventingthehighratesofmorbidityandmortality,includingdiuretictherapy,[15]repeatedlumbarpuncture,[16]streptokinasetherapy[17]andacombinationnovelinterventioncalledDRIFT(drainage,irrigationandfibrinolytictherapy).[citationneeded]Moreresearchisrequired,intheformofhighqualityrandomizedcontrolledtrials,todeterminethesafety,dosing,andeffectivenessofprophylacticheparinandantithrombintreatmentforpretermneonates.[8][18] Prognosis[edit] Ininfants,germinalmatrixhaemorrhageisassociatedwithcerebralpalsy,problemswithcognition,andhydrocephalus.[19]Withimprovedtechnologicaladvancesinscienceandmedicine,survivalforpreterminfantswiththistypeofneurologicaldisorderhasimprovedandlesspreterminfantswithgerminalmatrixhaemorrhagehaveseverecerebralpalsy.[19]Anestimated15%ofpreterminfantswhosurvivedevelopcerebralpalsyand27%oftheinfantswhosurviveexperiencemoderatetosevereneurosensorydeficitsbythetimetheyreach18-24monthsold.[19] PrognosisisverypoorwhenIVHresultsfromintracerebralhemorrhagerelatedtohighbloodpressureandisevenworsewhenhydrocephalusfollows.[1]ItcanresultindangerousincreasesinICPandcancausepotentiallyfatalbrainherniation.[1]Evenindependently,IVHcancausemorbidityandmortality.First,intraventricularbloodcanleadtoaclotintheCSFconduitsblockingitsflowandleadingtoobstructivehydrocephaluswhichmayquicklyresultinincreasedintracranialpressureanddeath.[13]Second,thebreakdownproductsfromthebloodclotmaygenerateaninflammatoryresponsethatdamagesthearachnoidgranulations,inhibitingtheregularreabsorptionofCSFandresultinginpermanentcommunicatinghydrocephalus.[2][13] Associatedconditions[edit] BraincontusionsandsubarachnoidhemorrhagesarecommonlyassociatedwithIVH.[20]Thebleedingcaninvolvetheanteriorcommunicatingarteryortheposteriorcommunicatingartery. Inbothadultsandinfants,IVHcancausedangerousincreasesinICP,damagetothebraintissue,andhydrocephalus.[9][21] Epidemiology[edit] IVHhasbeenreportedtooccurinapproximately25%ofinfantswhoarebornwithaverylowbirthweight.[8]Inpreterminfants,intraventricularhaemorrhageandgerminalmatrixhaemorrhagearethemostwidelyreportedneurologicaldisorders.[19]Approximately12,000infantseachyeararediagnosedwithgerminalmatrixhaemorrhageorintraventricularhaemorrhageintheUnitedStates.[19] Research[edit] Thisarticleneedsmoremedicalreferencesforverificationorreliestooheavilyonprimarysources,specifically:SecondarysourcesneededhereasperWP:MEDRS.Pleasereviewthecontentsofthearticleandaddtheappropriatereferencesifyoucan.Unsourcedorpoorlysourcedmaterialmaybechallengedandremoved.Findsources: "Intraventricularhemorrhage" – news ·newspapers ·books ·scholar ·JSTOR(March2021) In2002,aDutchretrospectivestudy[22]analysedcaseswhereneonatologistshadintervenedanddrainedCSFbylumbarorventricularpuncturesifventricularwidth(asshownonultrasound)exceededthe97thcentileasopposedtothe97thcentileplus4 mm.[23]ProfessorsWhitelaw'soriginalCochranereview[15]publishedin2001aswellasevidencefrompreviousrandomisedcontroltrialsindicatedthatinterventionsshouldbebasedonclinicalsignsandsymptomsofventriculardilatation.Aninternationaltrialhasinsteadlookedanearly(97thcentile)versuslate(97thcentileplus4 mm)forinterveninganddrainingCSF.[24] DRIFThasbeentestedinaninternationalrandomisedclinicaltrial;althoughitdidnotsignificantlylowertheneedforshuntsurgery,severecognitivedisabilityattwoyearsBayley(MDI<55)wassignificantlyreduced.[25]Repeatedlumbarpuncturesareusedwidelytoreducetheeffectsinincreasedintracranialpressureandanalternativetoventriculoperitoneal(VP)shuntsurgerythatcannotbeperformedincaseofintraventricularhaemorrhage.Therelativeriskofrepeatedlumbarpunctureiscloseto1.0,thereforeitisnotstatisticallytherapeuticwhencomparedtoconservativemanagementanddoesraisetheriskofsubsequentCSFinfection.[16] References[edit] ^abcYadav,Yad;Mukerji,Gaurav;Shenoy,Ravikiran;Basoor,Abhijeet;Jain,Gaurav;Nelson,Adam(2007)."Endoscopicmanagementofhypertensiveintraventricularhaemorrhagewithobstructivehydrocephalus".BMCNeurology.7:1.doi:10.1186/1471-2377-7-1.PMC 1780056.PMID 17204141. ^abcdefHinson,Holly;Hanley,Daniel;Ziai,Wendy(March2010)."ManagementofIntraventricularHemorrhage".CurrentNeurologyandNeuroscienceReports.10(2):73–82.doi:10.1007/s11910-010-0086-6.PMC 3138489.PMID 20425231. ^BarkleyJM,MoralesD,HaymanLA,Diaz-MarchanPJ(2006)."StaticneuroimagingintheevaluationofTBI".InZaslerND,KatzDI,ZafonteRD(eds.).BrainInjuryMedicine:PrinciplesandPractice.DemosMedicalPublishing.pp. 140–43.ISBN 1-888799-93-5. ^DawoduS.2007."TraumaticBrainInjury:Definition,Epidemiology,Pathophysiology"Emedicine.com.RetrievedonJune19,2007. ^VinasFCandPilitsisJ.2006."PenetratingHeadTrauma."Emedicine.com. ^abcGates,Peter;Barnett,Henry;Vinters,Harry;Simonsen,Randall;Siu,Kevin(1986)."PrimaryIntraventricularHemorrhageinAdults"(PDF).Stroke.17(5):872–877.doi:10.1161/01.STR.17.5.872.PMID 3764957. ^abBallabh,Praveen;deVries,LindaS.(2021-01-27)."Whitematterinjuryininfantswithintraventricularhaemorrhage:mechanismsandtherapies".NatureReviews.Neurology.doi:10.1038/s41582-020-00447-8.ISSN 1759-4766.PMID 33504979. ^abcBruschettini,Matteo;Romantsik,Olga;Zappettini,Simona;Banzi,Rita;Ramenghi,LucaAntonio;Calevo,MariaGrazia(2016-05-05)."Heparinforthepreventionofintraventricularhaemorrhageinpreterminfants".TheCochraneDatabaseofSystematicReviews(5):CD011718.doi:10.1002/14651858.CD011718.pub2.ISSN 1469-493X.PMID 27148674. ^abcAnnibaleDJandHillJ.2006.PeriventricularHemorrhage-IntraventricularHemorrhage.Emedicine.com.RetrievedonJune19,2007. ^Jobe,AlanH.(2004)."Post-conceptionalageandIVHinECMOpatients".TheJournalofPediatrics.145(2):A2.doi:10.1016/j.jpeds.2004.07.010. ^Suksumek,N;Scott,JN;Chadha,R;Yusuf,K(July2013)."Intraventricularhemorrhageandmultipleintracranialcystsassociatedwithcongenitalcytomegalovirusinfection".JournalofClinicalMicrobiology.51(7):2466–8.doi:10.1128/JCM.00842-13.PMC 3697656.PMID 23678057. ^abRomantsik,Olga;Calevo,MariaGrazia;Bruschettini,Matteo(2020-07-07)."Headmidlinepositionforpreventingtheoccurrenceorextensionofgerminalmatrix-intraventricularhaemorrhageinpreterminfants".TheCochraneDatabaseofSystematicReviews.7:CD012362.doi:10.1002/14651858.CD012362.pub3.ISSN 1469-493X.PMC 7389561.PMID 32639053. ^abcdNaff,Neal(June1,1999)."Intraventricularhemorrhageinadults".CurrentTreatmentOptionsinNeurology.1(3):173–178.doi:10.1007/s11940-999-0001-0.PMID 11096707.S2CID 32454951. ^JaliyaR.Lokuketagoda,"Twocasesofintraventricularhemorrhageevacuationbyopencraniotomyassistedwithstereotaxy,leadingtoexcellentresults",world-sci.com ^abWhitelaw,Andrew;Brion,LucP;Kennedy,ColinR;Odd,David(2001).Whitelaw,Andrew(ed.)."Diuretictherapyfornewborninfantswithposthemorrhagicventriculardilatation".CochraneDatabaseofSystematicReviews(2):CD002270.doi:10.1002/14651858.CD002270.PMC 8436729.PMID 11406041. ^abWhitelaw,Andrew(2001).Whitelaw,Andrew(ed.)."Repeatedlumbarorventricularpuncturesinnewbornswithintraventricularhemorrhage".CochraneDatabaseofSystematicReviews.doi:10.1002/14651858.CD000216. ^Whitelaw,Andrew;Odd,David;Brion,LucP;Kennedy,CR(2007).Whitelaw,Andrew(ed.)."Intraventricularstreptokinaseafterintraventricularhemorrhageinnewborninfants".CochraneDatabaseofSystematicReviews.2007(4):CD000498.doi:10.1002/14651858.CD000498.pub2.PMC 7032544.PMID 17943743. ^Bruschettini,Matteo;Romantsik,Olga;Zappettini,Simona;Banzi,Rita;Ramenghi,LucaAntonio;Calevo,MariaGrazia(2016-03-21)."Antithrombinforthepreventionofintraventricularhemorrhageinverypreterminfants".TheCochraneDatabaseofSystematicReviews.3:CD011636.doi:10.1002/14651858.CD011636.pub2.ISSN 1469-493X.PMID 26998583. ^abcdeBallabh,Praveen;deVries,LindaS.(2021-01-27)."Whitematterinjuryininfantswithintraventricularhaemorrhage:mechanismsandtherapies".NatureReviews.Neurology.doi:10.1038/s41582-020-00447-8.ISSN 1759-4766.PMID 33504979. ^Leroux,PeterD.;Haglund,MichaelM.;Newell,DavidW.;Grady,M.Sean;Winn,H.Richard(1992)."IntraventricularHemorrhageinBluntHeadTrauma".Neurosurgery.31(4):678–84,discussion684–5.doi:10.1227/00006123-199210000-00010.PMID 1407453. ^Mayfrank,L.;Kissler,J.;Raoofi,R.;Delsing,P.;Weis,J.;Küker,W.;Gilsbach,J.M.;Muizelaar,J.P.(1997)."VentricularDilatationinExperimentalIntraventricularHemorrhageinPigs:CharacterizationofCerebrospinalFluidDynamicsandtheEffectsofFibrinolyticTreatment".Stroke.28(1):141–8.doi:10.1161/01.STR.28.1.141.PMID 8996503. ^deVries,LS;Liem,KD;VanDijk,K;Smit,BJ;Sie,L;Rademaker,KJ;Gavilanes,AWD;DutchWorkingGroupofNeonatalNeurology(2007)."Earlyversuslatetreatmentofpost-haemorrhagicventriculardilatation:ResultsofaretrospectivestudyfromfiveneonatalintensivecareunitsintheNetherlands".ActaPaediatrica.91(2):212–7.doi:10.1111/j.1651-2227.2002.tb01697.x.PMID 11952011.S2CID 24234952. ^Volpe,JosephJ.(1989)."Intraventricularhemorrhageintheprematureinfant?currentconcepts.PartI".AnnalsofNeurology.25(1):3–11.doi:10.1002/ana.410250103.PMID 2913926.S2CID 41921817. ^Bristol,Universityof."BristolNeonatalNeurologyGroup-BristolMedicalSchool:TranslationalHealthSciences-UniversityofBristol".www.bris.ac.uk.Retrieved17April2018. ^Whitelaw,A.;Jary,S.;Kmita,G.;Wroblewska,J.;Musialik-Swietlinska,E.;Mandera,M.;Hunt,L.;Carter,M.;Pople,I.(2010)."RandomizedTrialofDrainage,IrrigationandFibrinolyticTherapyforPrematureInfantswithPosthemorrhagicVentricularDilatation:DevelopmentalOutcomeat2years".Pediatrics.125(4):e852–8.doi:10.1542/peds.2009-1960.PMID 20211949.S2CID 33833103. Externallinks[edit] ClassificationDICD-10:I61.5,P10.2,P52ICD-9-CM:431,772.1MeSH:D002543DiseasesDB:6906ExternalresourceseMedicine:ped/2595 00511atCHORUS UltrasoundPicturesofGerminalMatrixIVHMedPixImageDatabase vteCerebrovasculardiseasesincludingstrokeIschaemicstrokeBrain Anteriorcerebralarterysyndrome Middlecerebralarterysyndrome Posteriorcerebralarterysyndrome Amaurosisfugax Moyamoyadisease Dejerine–Roussysyndrome Watershedstroke Lacunarstroke Brainstem Brainstemstrokesyndrome Medulla Medialmedullarysyndrome Lateralmedullarysyndrome Pons Medialpontinesyndrome/Foville's Lateralpontinesyndrome/Millard-Gubler Midbrain Weber'ssyndrome Benediktsyndrome Claude'ssyndrome Cerebellum Cerebellarstrokesyndrome Extracranialarteries Carotidarterystenosis precerebral Anteriorspinalarterysyndrome Vertebrobasilarinsufficiency Subclavianstealsyndrome Classification Brainischemia Cerebralinfarction Classification Transientischemicattack Totalanteriorcirculationinfarct Partialanteriorcirculationinfarct Other CADASIL Binswanger'sdisease Transientglobalamnesia HaemorrhagicstrokeExtra-axial Epidural Subdural Subarachnoid Cerebral/Intra-axial Intraventricular Brainstem Durethaemorrhages General Intracranialhemorrhage Aneurysm Intracranialaneurysm Charcot–Bouchardaneurysm Other Cerebralvasculitis Cerebralvenoussinusthrombosis vteConditionsoriginatingintheperinatalperiod/fetaldiseaseMaternalfactorscomplicatingpregnancy,labourordeliveryplacenta Placentapraevia Placentalinsufficiency Twin-to-twintransfusionsyndrome chorion/amnion Chorioamnionitis umbilicalcord Umbilicalcordprolapse Nuchalcord Singleumbilicalartery presentation Breechbirth Asynclitism Shoulderpresentation Growth Smallforgestationalage/Largeforgestationalage Pretermbirth/Posttermpregnancy Intrauterinegrowthrestriction Birthtrauma scalp Cephalohematoma Chignon Caputsuccedaneum Subgalealhemorrhage Brachialplexusinjury Erb'spalsy Klumpkeparalysis AffectedsystemsRespiratory Intrauterinehypoxia Infantrespiratorydistresssyndrome Transienttachypneaofthenewborn Meconiumaspirationsyndrome Pleuraldisease Pneumothorax Pneumomediastinum Wilson–Mikitysyndrome Bronchopulmonarydysplasia Cardiovascular Pneumopericardium Persistentfetalcirculation Bleedingandhematologicdisease VitaminKdeficiencybleeding HDN ABO Anti-Kell Rhc RhD RhE Hydropsfetalis Hyperbilirubinemia Kernicterus Neonataljaundice Velamentouscordinsertion Intraventricularhemorrhage Germinalmatrixhemorrhage Anemiaofprematurity Gastrointestinal Ileus Necrotizingenterocolitis Meconiumperitonitis Integumentandthermoregulation Erythematoxicum Scleremaneonatorum Nervoussystem Perinatalasphyxia Periventricularleukomalacia Musculoskeletal Graybabysyndrome muscletone Congenitalhypertonia Congenitalhypotonia Infections Verticallytransmittedinfection Neonatalinfection rubella herpessimplex mycoplasmahominis ureaplasmaurealyticum Omphalitis Neonatalsepsis GroupBstreptococcalinfection Neonatalconjunctivitis Other Miscarriage Perinatalmortality Stillbirth Infantmortality Neonatalwithdrawal vteNeurotraumaTraumaticbraininjury Intracranialhemorrhage Intra-axial Intraparenchymalhemorrhage Intraventricularhemorrhage Extra-axial Subduralhematoma Epiduralhematoma Subarachnoidhemorrhage Brainherniation Cerebralcontusion Cerebrallaceration Concussion Post-concussionsyndrome Second-impactsyndrome Dementiapugilistica Chronictraumaticencephalopathy Diffuseaxonalinjury Abusiveheadtrauma Penetratingheadinjury Spinalcordinjury Anteriorspinalarterysyndrome Brown-Séquardsyndrome Caudaequinasyndrome Centralcordsyndrome Paraplegia Posteriorcordsyndrome Spinalcordinjurywithoutradiographicabnormality Tetraplegia(Quadriplegia) Peripheralnerves Nerveinjury Peripheralnerveinjury classification Walleriandegeneration Injuryofaccessorynerve Brachialplexusinjury Traumaticneuroma Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Intraventricular_hemorrhage&oldid=1057329200" Categories:NeurotraumaHiddencategories:ArticleswithshortdescriptionShortdescriptionisdifferentfromWikidataAllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromMarch2021ArticlesneedingadditionalmedicalreferencesfromMarch2021AllarticlesneedingadditionalreferencesArticlesrequiringreliablemedicalsources Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk Variants expanded collapsed Views ReadEditViewhistory More expanded collapsed Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Languages العربيةবাংলাCatalàItalianoעבריתNederlandsPolski Editlinks