Intraventricular Hemorrhage

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Intraventricular Hemorrhage (IVH) is an accumulation of blood within the ventricular system that may occur spontaneously (from hypertension, blood thinners), from tumors or vascular malformations or as a result of a surgical intervention. IVH may obstruct the normal flow and reabsorption of cerebrospinal fluid and cause hydrocephalus. Treatments include external ventricular drainage, ventriculoperitoneal shunting, and instillation of the potent blood thinner Tissue Plasminogen Activator (TPA) directly into the ventricular system (Figure 1, 2). Over time the coagulum is metabolized by the body; an assessment of the status of CSF reabsorption is then undertaken to anticipate symptomatic hydrocephalus.

Figure 1
Top row: Axial CT demonstrates an extensive intraventricular and subarachnoid hemorrhage on day of admission with associated hydrocephalus. Bottom row: Demonstrates near complete resolution of IVH after four doses of intrathecal tissue plasminogen activator (TPA).

Before Intraventricular Hemorrhage After Intraventricular Hemorrhage

Figure 2
Images obtained before and after treatment of intraventricular hemorrhage with EVD and intraventricular TPA.

Frequently Asked Questions (FAQs) About Intraventricular Hemorrhage

What causes intraventricular hemorrhage?

IVH can occur spontaneously (from hypertension or blood thinners), from tumors or vascular malformations, or as a result of a surgical intervention.

Can intraventricular hemorrhage cause other complications?

Yes, it may obstruct the normal flow and reabsorption of cerebrospinal fluid, which can lead to hydrocephalus.

How is intraventricular hemorrhage treated?

Treatment depends on the severity of the hemorrhage and whether it causes hydrocephalus, or a buildup of fluid and pressure in the brain. An external ventricular drain (EVD) may be placed to drain cerebrospinal fluid and relieve pressure. In selected patients, a clot-dissolving medication such as alteplase (tPA) may be administered through the drain to help clear blood from the ventricles. Some patients with persistent hydrocephalus may require a permanent ventriculoperitoneal (VP) shunt.

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