Chapter 64 - Intraventricular Hemorrhage

Abstract

Bleeding directly into the ventricles from a source or lesion that is in contact with or is part of a ventricular wall, such as a vascular malformation or neoplasm, is classified as primary intraventricular hemorrhage (IVH). This type of IVH without an associated parenchymal hematoma is rare, accounting for only about 3% of all spontaneous intracerebral hemorrhages (ICHs). 1 Much more commonly, IVH is secondary either to intracerebral bleeding that dissects through brain parenchyma to reach a ventricle or to bleeding into the subarachnoid space that spreads into the ventricles through the fourth ventricular foraminae. Primary or secondary IVHs can fill one or more ventricles and, when of sufficient volume and density, can result in formed ventricular blood clots, or hematocephalus . Blood that refluxes into the ventricles from the subarachnoid space often remains unclotted and settles in dependent parts of the ventricular system. Although the presence of IVH per se does not always correlate with neurologic condition or prognosis, IVH is an independent and important clinical problem when clots distend the ventricular system, compress adjacent brain, or obstruct cerebrospinal fluid (CSF) flow to cause hydrocephalus and elevated intracranial pressure (ICP).