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intraventricular haemorrhage (IVH) in adults


  • non-traumatic bleeding into the intracranial ventricles in adults is generally the result of either:
    • extension of intracerebral haemorrhage (usually in the thalamic ganglionic region) which is generally caused by:
      • chronic hypertension causing development of Charcot-Bouchard aneurysms and thus incidence of ICH doubles for each decade over 50yrs age until 80yrs in those with HT
      • hypertensive crisis
      • drug abuse
      • autoregulatory dysfunction of cerebral blood flow (especially if thrombolytics used):
        • reperfusion injury
        • haemorrhagic transformation of ischaemic stroke
        • cold exposure
      • altered clotting system:
      • arteriopathy
      • haemorrhagic necrosis (neoplasm, infection)
      • cerebral venous thrombosis raising intracerebral vascular pressures
    • bleeding from subependymal structures:
      • germinal matrix (mainly neonates)
      • AV malformation
      • cavernous angioma

clinical features

  • onset usually during daytime activities and progressive development over minutes to hours of:
  • acute onset headache in 40%
  • vomiting in 40-50%
  • decreased mental state in 50%
  • seizures in < 10%
  • +/- focal neurology
    • NB. prodromal focal neurology may occur in lobar ICH associated with cerebral amyloid angiopathy

Mx in ED

  • most require Mx in a resuscitation room if deemed Mx is not futile
  • iv access, bloods for FBE, U&E, clotting profile
  • nurse at 30deg head up
  • ABC's and consider early intubation if GCS is < 8
  • CT brain to confirm bleed
  • urgently reverse coagulopathy if possible
  • liaise with neurosurgery
ivh_adult.txt · Last modified: 2016/01/20 18:10 (external edit)