[Traumatic intraventricular hemorrhage in severe head injury]

Among 329 cases with comatose state caused by severe head injury, 32 had primary intraventricular hemorrhage as revealed on initial CT scan (13.4%). We divided traumatic intraventricular hemorrhage into 4 types. Type 1: massive hemorrhage (9 cases). Type 2: subependymal hemorrhage (8 cases). Type 3: damage of fornix or septum pellucidum (8 cases). Type 4: Nieveau (7 cases). Most of these cases were caused by traffic accident. Shearing injury may be the most accurate mechanism to produce the intraventricular hemorrhage. Shear strain in severe head injury should cause tears of the subependymal vein, fornix, septum pellucidum and choroid plexus. 8 cases out of 32 ventricular hemorrhage showed tear of the subependymal vein. 8 of our cases showed damage of the fornix of septum pellucidum. These results suggested that the anatomical structure of the fornix and septum pellucidum were weak points for shearing force. 20 cases in 32 with ventricular hemorrhage died. These cases were frequently associated with other traumatic lesions, namely contusion of white matter and grey matter, brain stem lesions and cerebellar contusion, caused by shearing injury. Therefore, the prognosis of severe head injury with intraventricular hemorrhage is poor.