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Current management of intraventricular hemorrhage
Herbert H Engelhard1, Carlota O Andrews, Konstantin V Slavin
1Department of Neurosurgery, College of Medicine, The University of Illinois at Chicago, 912 South Wood Street, Chicago, IL 60612, USA.
Surgical Neurology
|July 17, 2003
Summary
Intraventricular hemorrhage (IVH) treatment with fibrinolytic agents like tissue plasminogen activator (t-PA) may reduce mortality in severe cases. Current practice involves administering t-PA for significant IVH after addressing bleeding sources.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Intraventricular hemorrhage (IVH) poses significant challenges in neurosurgery, associated with high morbidity and mortality.
- Current management often involves external ventricular drains (EVDs), which can be occluded by blood clots, prolonging hemorrhage duration.
- Limited cerebrospinal fluid fibrinolytic activity contributes to persistent blood in ventricles, impacting patient prognosis.
Purpose of the Study:
- To review recent literature on intraventricular hemorrhage (IVH) treatment strategies.
- To describe the current management approach for patients diagnosed with IVH.
Main Methods:
- Conducted a literature search focusing on recent articles regarding IVH pathophysiology and treatment.
- Screened bibliographies of selected publications for additional relevant studies.
Main Results:
- Fibrinolytic therapy administered intraventricularly has shown a 30-35% reduction in mortality for IVH.
- While mortality is reduced, improved neurological outcomes in survivors of fibrinolytic therapy are not yet clearly documented.
- External ventricular drains (EVDs) are a primary method for managing intracranial pressure but are prone to occlusion by coagulated blood.
Conclusions:
- Intraventricular fibrinolytic therapy, specifically using tissue plasminogen activator (t-PA), can be life-saving in severe IVH cases.
- Current clinical practice involves administering intraventricular t-PA for significant IVH (>=30% ventricular volume) after excluding or treating sources of bleeding, such as aneurysms.
- Further research is needed to address unresolved issues and optimize the use of fibrinolytic agents in IVH management.