[The relationship between hemorrhagic dilation of the fourth ventricle and outcome]

52 adult patients with CT-documented fourth intraventricular hemorrhage (FIVH) were treated. The various etiologic findings included intraparenchymal hemorrhage with secondary FIVH (24 cases), spontaneous subarachnoid hemorrhage (8), spontaneous IVH (12), and trauma (8). Of the 52 patients, 28 died because of hemorrhagic dilation of the fourth ventricle in spite of aggressive therapy. Of the 24 FIVH patients without dilation, 10 died and 14 survived. The survival rate for the patients with hemorrhagic dilation of the fourth ventricle was significantly lower than that for FIVH patients without dilation. Of the 28 patients with FIVH associated with dilation, 24 presented with a Glasgow Coma Scale (GCS) score of less than 5 or 5, 2 with a GCS score of 7, and 2 with a GCS score of 13. In the 24 FIVH patients without dilation, 8 presented with a GCS score of 3 to 5 (seven died and one survived), 4 with a GCS score of 6 to 8 (two died and two had survival), 5 with a GCS score of 9 to 12 (one died and four had survival), and 7 with a GCS score of 13 to 15. There was a great difference of GCS scores between the two groups. Logistic regression multivariate analysis demonstrated that hemorrhagic dilation of the fourth ventricle was the most significant outcome predictor, followed by GCS score and then the presence of diffuse IVH.