Cerebral intraventricular haemorrhage in a young adult

A case of a 26-year-old man who suffered a fatal intraventricular cerebral haemorrhage following an episode of trauma is described. The initial appearance at necropsy suggested a traumatic subarachnoid haemorrhage and initial investigation was directed towards the anterior neck structures and the vertebral arteries with negative results. Dissection of the fixed brain showed a massive intraventricular bleed with secondary involvement of the subarachnoid space and dissection into the cerebral parenchyma. No bleeding points or natural disease of the cerebral vessels could be identified. The practical aspects of diagnosis and the cautious approach necessary in interpreting subarachnoid bleeding is emphasised. The significance of intraventricular haemorrhage following trauma has become more apparent with the advent of computed tomographic scanning. The implications for this and similar cases are considered.