J Cerebrovasc Endovasc Neurosurg.  2019 Mar;21(1):18-23. 10.7461/jcen.2019.21.1.18.

Solitary intraventricular hemorrhage without subarachnoid hemorrhage due to aneurysmal rupture: a case report

• Kim SS
• Go KO
• Park H
• Lee K
• Ryu GH
• Baek HJ
• Jung S
• Yoon CH
• Park YS
• Hwang SH

• KMID: 2465011
• DOI: http://doi.org/10.7461/jcen.2019.21.1.18

Abstract

The presence of primary intraventricular hemorrhage (IVH) without vascular lesion is very rare. We experienced solitary IVH without subarachnoid hemorrhage due to aneurysmal rupture in a 58-year-old man treated with coil embolization, which contributed to his good prognosis. After 33 days of hospitalization, he had mild right hemiplegic symptoms remaining, and he was transferred to a rehabilitation institute for further treatment. In cases of primary IVH, computed tomography angiography seems worthwhile for making a differential diagnosis, although the possibility of IVH due to cerebral aneurysmal rupture is very low. Endovascular intervention is a good option for diagnosis and treatment.

Keyword

Cerebral angiography; Intraventricular hemorrhage; Intracranial aneurysm; Endovascular procedures; Subarachnoid hemorrhage

MeSH Terms

Aneurysm*
Angiography
Cerebral Angiography
Diagnosis
Diagnosis, Differential
Embolization, Therapeutic
Endovascular Procedures
Hemorrhage*
Hospitalization
Humans
Intracranial Aneurysm
Middle Aged
Prognosis
Rehabilitation
Rupture*
Subarachnoid Hemorrhage*

Figure

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  Fig. 1 The initially checked non-contrast-enhance computed tomography scans. A: The hemorrhage is expanded through the foramen Monro to the contralateral anterior horn of the lateral and third ventricles. B: No definite subarachnoid hemorrhage is observed on the initial computed tomography scan.

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  Fig. 2 Computed tomography angiography is performed for the differential diagnosis. A: Three-dimensional reconstruction image shows the aneurysm in left distal internal carotid artery. B: Computed tomography angiogram of the coronal section.

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  Fig. 3 Conventional cerebral angiogram clearly showing the aneurysm arising from the left anterior choroidal artery. A: Digital subtraction angiogram in the lateral view showing the left internal carotid artery. B and C: Three-dimentional reconstruction images showing the aneurysm more precisely.

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  Fig. 4 A: Preoperative digital subtraction angiogram shows the endovascular catheter tip being advanced at the aneurysmal neck. B: Postoperative digital subtraction angiogram shows successful endovascular embolization and no emboli in distal blood flows.

Reference

1. Anagnostopoulos C, Chamilos C, Hadjigeorgiou G, Petsanas A. Isolated massive intraventricular haemorrhage without subarachnoid haemorrhage due to rupture of a posterior communicating artery aneurysm. Br J Neurosurg. 2017; 04. 1–2.

2. Angelopoulos M, Gupta SR, Kia BA. Primary intraventricular hemorrhage in adults: clinical features, risk factors, and outcome. Surg Neurol. 1995; 05. 44(5):433–436. discussion 437.

3. Darby D, Donnan G, Saling M, Walsh K, Bladin P. Primary intraventricular hemorrhage: clinical and neuropsychological findings in a prospective stroke series. Neurology. 1988; 01. 38(1):68–75.

4. Flint AC, Roebken A, Singh V. Primary intraventricular hemorrhage: yield of diagnostic angiography and clinical outcome. Neurocrit Care. 2008; 03. 8(3):330–336.

5. Gates PC, Barnett HJM, Vinters HV, Simonsen RL, Siu K. Primary intraventricular hemorrhage in adults. Stroke. 1986; 02. 17(5):872–877.

6. Inagawa T, Matsuda Y, Kamiya K, Aoyama H, Nagasako R, Yamamoto M. Saccular aneurysm of the distal anterior choroidal artery--case report. Neurol Med Chir (Tokyo). 1990; 03. 30(7):498–502.

7. Jayakumar PN, Taly AB, Bhavani UR, Arya BYT, Nagaraja D. Prognosis in solitary intraventricular haemorrhage. Clinical and computed tomographic observations. Acta Neurol Scand. 1989; 07. 80(1):1–5.

8. Knuckey NW, Epstein MH, Haas R, Sparadeo F. Distal anterior choroidal artery aneurysm: intraoperative localization and treatment. Neurosurgery. 1988; 06. 22(6 Pt 1):1084–1087.

9. Konishi Y, Kadowaki C, Hara M, Takeuchi K. Aneurysms associated with moyamoya disease. Neurosurgery. 1985; 16(4):484–491.

10. Martí-Fàbregas J, Piles S, Guardia E, Martí-Vilalta JL. Spontaneous primary intraventricular hemorrhage: clinical data, etiology and outcome. J Neurol. 1999; 04. 246(4):287–291.

11. Nakagawa K, Lee SB. Predominant intraventricular hemorrhage from a ruptured posterior communicating artery aneurysm. Neurohospitalist. 2014; 10. 4(3):164.

12. Nishihara J, Kumon Y, Matsuo Y, Sakaki S. A case of distal anterior choroidal artery aneurysm: case report and review of the literature. Neurosurgery. 1993; 05. 32(5):834–837. discussion 837.

13. Papo I, Salvolini U, Caruselli G. Aneurysm of the anterior choroidal artery with intraventricular hematoma and hydrocephalus. Case report. J Neurosurg. 1973; 08. 39(2):255–260.

14. Ragland RL, Gelber ND, Wilkinson HA, Knorr JR, Tran AA. Anterior communicating artery aneurysm rupture: an unusual cause of acute subdural hemorrhage. Surg Neurol. 1993; 40(5):400–402.

15. Ranjan A, Joseph T. Giant aneurysm of anterior ethmoidal artery presenting with intracranial hemorrhage. Case report. J Neurosurg. 1994; 12. 81(6):934–936.

16. Roos YB, Hasan D, Vermeulen M. Outcome in patients with large intraventricular haemorrhages: a volumetric study. J Neurol Neurosurg Psychiatry. 1995; 05. 58(5):622–624.

17. Rosenorn J, Westergaard L, Hansen PH. Mannitol-induced rebleeding from intracranial aneurysm. Case report. J Neurosurg. 1983; 09. 59(3):529–530.

18. Sandin JA, Salamat MS, Baskaya M, Dempsey RJ. Intracerebral hemorrhage caused by the rupture of a nontraumatic middle meningeal artery aneurysm. Case report and review of the literature. J Neurosurg. 1999; 05. 90(5):951–954.

19. Tanaka Y, Ogashiwa M, Takeuchi K. Moyamoya phenomenon with accompanying intracranial aneurysm. Neuroradiology. 1978; 12. 16(1):289–290.

20. Tembl J, Lago A, Baquero M, Blasco R. Primary intraventricular hemorrhage: an analysis of eight cases. Rev Neurol. 1997; 25(138):215–218.

21. Venti M. Subarachnoid and intraventricular hemorrhage. Front Neurol Neurosci. 2012; 30:149–153.

22. Voldby B, Enevoldsen EM. Intracranial pressure changes following aneurysm rupture. Part 3: Recurrent hemorrhage. J Neurosurg. 1982; 06. 56(6):784–789.

23. Weinstein R, Ess K, Sirdar B, Song S, Cutting S. Primary Intraventricular Hemorrhage: Clinical Characteristics and Outcomes. J Stroke Cerebrovasc Dis. 2017; 05. 26(5):995–999.

24. Weisberg LA. Computerized tomography in intracranial hemorrhage. Arch Neurol. 1979; 07. 36(7):422–426.

25. Yeung R, Ahmad T, Aviv RI, de Tilly LN, Fox AJ, Symons SP. Comparison of CTA to DSA in determining the etiology of spontaneous ICH. Can J Neurol Sci. 2009; 03. 36(2):176–180.

26. Yoneoka Y, Ezuka I, Takai N, Oda T, Tamura T, Yamashita S. Ruptured distal anterior choroidal artery aneurysm presenting with casting intraventricular haemorrhage. Acta Neurochir (Wien). 1998; 02. 140(2):185–189.