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Incidence and outcomes of intracerebral haemorrhage with mechanical compression hydrocephalus

Bryce Owen1, Omar Akbik2, Michel Torbey3

  • 1School of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.

Stroke and Vascular Neurology
|January 9, 2021
PubMed

Insights

Deep brain hemorrhages causing third ventricle compression lead to worse outcomes. This mechanical compression, requiring external ventricular drain (EVD), is linked to poorer functional recovery in patients with intracerebral hemorrhage (ICH).

Area of Science:

  • Neurosurgery
  • Neurology
  • Radiology

Background:

  • Intracerebral hemorrhage (ICH) in deep brain structures is linked to poorer outcomes than lobar ICH.
  • Mechanical compression of the third ventricle by clot burden may exacerbate poor outcomes by obstructing cerebrospinal fluid (CSF) outflow.

Purpose of the Study:

  • To review the incidence and outcomes of mechanical compression ICH.
  • To identify high-risk patients who may benefit from minimally invasive clot evacuation.

Main Methods:

  • Retrospective review of 287 patients with spontaneous supratentorial ICH over 30 months.
  • CT imaging assessed ICH location, volume, hydrocephalus requiring external ventricular drain (EVD), and third ventricle clearing time.
  • Hydrocephalus categorized as primarily intraventricular hemorrhage (IVH), mechanical compression, or mixed; outcomes assessed by modified Rankin Score (mRS).

Main Results:

  • 39 (13.5%) patients developed hydrocephalus requiring EVD, with significantly higher mRS at discharge (p≤0.001).
  • Mechanical compression hydrocephalus was associated with poorer outcomes compared to primary IVH hydrocephalus (p=0.037) and longer third ventricle clearing times (p=0.006).
  • Lobar ICH location correlated with better outcomes than thalamic ICH.

Conclusions:

  • Mechanical obstruction requiring EVD occurs in approximately 7.3% of supratentorial ICH patients.
  • It remains unclear if worse outcomes are solely due to deep structure damage or if secondary hydrocephalus damage could be mitigated by minimally invasive clot evacuation.
Abstract

Keywords:
haemorrhagehydrocephalusstroke

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