Abstract TP299: Lone Intraventricular Hemorrhage Frequently Harbors Vascular Malformations And Has Better Clinical Outcomes Than When Associated With Small Parenchymal Component

Abstract

Background: Primary intraventricular hemorrhage (PIVH) is an uncommon neurological event which can cause significant morbidity. The current literature comprises of small case series that include two types of PIVH: 1) blood restricted to the ventricular system only 2) predominant IVH plus a small parenchymal component. Hypothesis: We hypothesized that these two types represent different clinical entities and have key differences in their clinical, diagnostic and prognostic profiles. Methods: We performed a retrospective chart review over last 3 years from our center’s database. Neuroradiology reports of initial CT scans from all cases of intracranial hemorrhage (ICH) were reviewed to capture patients. Then CT images were reviewed and classified into pure IVH or IVH with small intraparenchymal hemorrhage within 15mm of the ventricular wall (IVH/sICH). Exclusion criteria included presence of subarachnoid hemorrhage and head trauma. Results: Out of 846 ICH patients, 25 patients (3%) were identified as pure IVH and 26 (3.1%) as IVH/sICH. Median ages were 72 and 61 years, and females were 17 (68%) and 14 (54%) without significant difference. Pure IVH was found to have significantly higher rate of cerebral angiogram performance (60% vs 26.9%, p=0.02), more frequent etiology of arteriovenous malformations (AVM) or arteriovenous fistula (32% vs 3.8%, p=0.01), better early clinical outcomes measured by median modified Rankin score at discharge (4 vs 5, p=0.05) and lower in-hospital mortality (0% vs 23.1%, p=0.02). IVH/sICH group was found to have significantly higher rate of focal findings on presentation (p=0.02) and past history of HTN (p=0.02). No significant differences were found between the groups in clinical presentation, admission blood pressure, pre-admission antiplatelet and anticoagulation therapy, severity of IVH on CT, CT angiogram findings, and in-hospital complication and treatment. Conclusion: Clinical presentation was not different between pure IVH and IVH with small parenchymal component. Pure IVH patients received a more aggressive diagnostic approach, had more frequent diagnosis of vascular malformation, and had better early clinical outcomes.