Original Article

Journal of Korean Neurosurgical Society. 1996; 25(8): 1614-1619.

Prognostic Effects of 4th Ventricular Hemorrhage in Intraventricular Hemorhage.

Won Seok Seok, Sung Rak Lee, Dong Gee Kang, and Sang Chul Kim

Department of Neurosurgery, Fatima Hospital, Taegu, Korea.

Intraventricular hemorrhage(IVH) from any source is generally considered to be of grave prognostic significance. However, little is known about the prognostic effect of fourth IVH. The analysis of 65 patients with computerized tomography(CT)-documented fourth IVH treated between 1990 and 1994 is here in presented. The etiologies of the studied fourth IVH include hypertensive intracranial hemorrhage(39 cases), spontaneous subarachnoid hemorrhage(12 cases), primary IVH(9 cases), trauma(4 cases), Moyamoya disease(1 case). A 66.7% mortality rate was found in patients with a Glasgow coma scale(GCS) score of 3 to 5, 53.8% for those with a GCS score of 6 to 8, 28.6% for those patients with a GCS score of 9 to 12, and 9.5% for patients with a GCS score of 13 to 15. Admission status was significant outcome predictor(p<0.001). The mortality rate for patients with dilatation and fixed pupil was 64.7%. Pupillary reflex was also used as an outcome predictor(p<0.05). The mortality rate of patients with hemorrhagic dilatati on of the fourth ventricle was 70% while those with no hemorrhagic dilatation of the fourth ventricle was 28.9%. Hemorrhagic dilatation of the fourth ventricle was a potent predictor of outcome in fourth IVH(p<0.005). The mortality rate of patients with a ventriculocranial ratio(VCR) of 0.23 or more than 0.23, as calculated from initial CT scan, was 76.5% and those with a VCR of less than 0.16 was 26.7%. We have found that VCR is a potent prodictor of outcome in fourth IVH(p<0.005). The prognostic values of age, etiology of fourth IVH, lood pressure, the number of ventricle of hemorrhage presenting was found to be statistically insignificant. Patients with all ventricular hemorrhage and urokinase irrigation have a 64.5% mortality rate. Patients with fourth IVH and hemorrhagic dilatation of fourth ventricle, increased VCR, poor admission status, dilatation and fixed pupil are considered poor prognosis. Urokinase irrigation was the recommended management for these patients.

Keywords : Intraventricular hemorrhage;Fourth ventricle;Outcome predictor;Hemorrhagic dilatation;Ventriculocranial ratio;Urokinase irrigation