Traumatic intraventricular hemorrhage treated with intraventricular recombinant-tissue plasminogen activator: technical case report.
OBJECTIVE
Traumatic intraventricular hemorrhage (IVH) can result in association with acute obstructive hydrocephalus, repetitive malfunction of external ventricular drains (EVDs), and uncontrollable increased intracranial pressure. We report a case showing the safe and effective use of intraventricular recombinant-tissue plasminogen activator in a child with severe brain injury and acute hydrocephalus from IVH.


METHODS
A 15-year-old male patient presented to us after a motor vehicle accident with bilateral extensor posturing, intracerebral and IVH, and acute obstructive hydrocephalus.


METHODS
A right EVD was placed and functioned only transiently. A left EVD was placed and functioned only transiently. Because of the inability to maintain ventricular drainage, rising intracranial pressure, and worsening clinical status, 5 mg of recombinant-tissue plasminogen activator was injected through each EVD. Excellent EVD function was obtained quickly, with control of intracranial pressure and improvement in clinical status and without hemorrhagic complication.


CONCLUSIONS
With obstructive hydrocephalus secondary to acute traumatic IVH that cannot be controlled with EVD because of recurrent obstruction from intraventricular blood, intraventricular recombinant-tissue plasminogen activator can be effective and safe, despite preexisting multiple hemorrhagic intracranial injuries.
Division of Neurosurgery, University of Alabama at Birmingham, Children's Hospital of Alabama, 35233, USA.
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Grabb
D000293:Adolescent; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D002552:Cerebral Ventricles / Q000293:injuries*; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D019586:Intracranial Hypertension / Q000628:therapy; D008297:Male; D011994:Recombinant Proteins / Q000008:administration & dosage; D012008:Recurrence; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D014696:Ventriculostomy
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator