Non-vascular structural-related intraventricular hemorrhage: Epidemiology and literature review

Primary intraventricular hemorrhage (PIVH) is a rare type of hemorrhagic stroke typically associated with vascular structural abnormalities. However, little is known about the epidemiology and etiology of PIVH caused by non-vascular structural abnormalities. In this study, we aimed to clarify the etiology, clinical characteristics, and prognosis of non-vascular structural-related intraventricular hemorrhage (NVSRIVH).

We retrospectively collected and analyzed data from 29 consecutive patients with NVSRIVH admitted to our hospital between January 2017 and May 2024. Outcomes were assessed using the modified Rankin Scale (mRS) at 90 days. A systematic review of the pertinent literature was performed and a pooled analysis of data from selected studies was performed.

Among 2035 patients with spontaneous intracerebral hemorrhage, 40 (2 %) had PIVH. After excluding patients with vascular abnormalities and those without cerebrovascular examination results, data for 29 patients (13 males and 16 females, average age: 66.38 ± 2.76 years) were analyzed. The most common initial symptom was headache (65.5 %), with a median Glasgow Coma Scale (GCS) of 12 (7, 15) and modified Graeb score (mGS) of 15 (6, 18). Chronic hypertension was the most common clinical risk factor (79.3 %). Surgical intervention was performed in 24 patients, most commonly external ventricular drainage (62.1 %). At the 90-day follow-up, 22 patients (74.49 %) had good outcomes (mRS ≤ 3), and 7 patients (21.43 %) had poor outcomes (mRS > 3). Logistic regression analyses showed that GCS scores at admission, mGS, and hydrocephalus are associated with poor outcomes.

NVSRIVH is a rare stroke subtype with a relatively good prognosis. NVSRIVH may be associated with long-term chronic disease, and chronic hypertension and age are the most relevant clinical risk factors.