Clinical Significance of Intraventricular Hemorrhage in Patients with Ruptured Aneurysms

Kim, Byoung Gu; Bae, Hack Gun; Yoon, Seok Mann; Yun, Il Gyu; Shim, Jai Joon; Kim, Sung Ho

Abstract

OBJECTIVE
The purpose of this study was to determine the clinical significance of intraventricular hemorrhage (IVH) in patients with ruptured aneurysms.
METHODS
Of 1034 patients who were admitted to our hospital with ruptured aneurysms between 1994 and 2007, 128 (12.4%) had IVHs. The clinical, radiologic characteristics, and surgical outcomes in the IVH group were compared with the no-IVH group.
RESULTS
The IVH group had a shorter time interval to admission. The incidence of IVH was significantly higher in patients > 70 years of age (p=0.021), males (p=0.000), alcohol abusers (p=0.039), patients with a Glagow Coma Scale (GCS) < or =8 (p=0.000), and patients with a Hunt and Hess grade of 4-5 (p=0.000). IVH was more common in patients with ruptured posterior circulation aneurysms (p=0.000) and anterior communicating artery aneurysms (p=0.036). The incidence of thick, diffuse subarachnoid hemorrhage (SAH; p=0.004), intracerebral hemorrhage (ICH) >10 cc (p=0.006), rebleeding (p=0.010), and shunt-dependant hydrocephalus (p=0.000) was significantly higher in the IVH group than the no-IVH group. The mortality rate in the IVH group was significantly higher than the no-IVH group (48.4% versus 22.1%). The amount of IVH had an influence on the mortality; IVH involving all of the ventricles (59.7%) and IVH only involving some of the ventricles (33.9%) was associated with a 6.6- and 2.3-fold higher mortality than the no-IVH group, respectively. IVH was significantly associated with a poor surgical outcome; however, this association was not significant in patients with a GCS < or =8, or histories of rebleeding or seizures.
CONCLUSIONS
In patients with ruptured aneurysms, IVH reflects the clinical severity of SAH. IVH has a negative influence on surgical outcome, except in patients with a poor clinical status pre-operatively.