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Cerebral vasospasm associated with intraventricular hemorrhage
Christopher Dull1, Michel T Torbey
1Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neurocritical Care
|September 22, 2005
Summary
Cerebral vasospasm can occur with primary intraventricular hemorrhage (IVH). This case highlights a patient whose behavioral changes were linked to increased cerebral blood flow velocity, suggesting vasospasm.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Cerebral vasospasm is a known complication of aneurysmal subarachnoid hemorrhage.
- Previous reports suggest vasospasm can occur with intraventricular hemorrhage (IVH) from ruptured arteriovenous malformations, even without subarachnoid hemorrhage.
Observation:
- A 44-year-old female presented with cerebellar infarction and subsequently developed primary IVH.
- Following IVH, she exhibited disorientation and a peculiar interest in counting numbers.
- This behavioral change correlated with a significant increase in middle cerebral artery blood flow velocity.
Findings:
- This report details the first known case of cerebral vasospasm associated with primary IVH.
- Transcranial Doppler revealed a doubling of middle cerebral artery M1 velocity.
- Symptoms resolved with triple H therapy (hypervolemia, hypertension, hemodilution).
Implications:
- Cerebral vasospasm may be an underrecognized comorbidity of primary IVH.
- Routine transcranial Doppler screening for vasospasm in IVH patients may be beneficial.
