A case of successful intraventricular thrombolysis and external ventricular drain treatment in primary intraventricular hemorrhage

Abstract

Intraventricular hemorrhage (IVH), accounting for about 45% of acute spontaneous intracranial hemorrhage (ICH), is often associated with obstructive hydrocephalus and poor functional outcomes [1] [2]. Obstructive hydrocephalus and increased intracranial pressure are common after IVH because of an obstruction of normal cerebrospinal fluid (CSF) flow and absorption by blood clots. An external ventricular drain (EVD) - a temporary system that permits drainage of cerebral spinal fluid (CSF) from the ventricles to an external closed system) has been indicated for patients with IVH with hydrocephalus and neurologic decline [3]. However, the treatment with EVD alone is often not sufficiently effective due to a likely potential obstruction of the catheter by blood clots. Intraventricular fibrinolysis (IVF) via the extra-ventricular drain has been known to speed clot resolution and maintain the EVD functionality [4]. However, it is also possible that the risk of hemorrhage, infection, and CFS pleocytosis may be increased with IVF therapy, but these have not been demonstrated so far. We report a clinical case of primary IVH with acute obstructive hydrocephalus, successfully treated with a combination of EVD and direct intraventricular injection of rt-PA into the lateral ventricles. This treatment contributes to confirm that combination of EVD and thrombolysis could be considered as a treatment option for selected patients.