title: A priority treatment of the intraventricular hemorrhage (IVH) should be performed in the patients suffering intracerebral hemorrhage with large IVH.
abstract: BACKGROUND
  In patients suffering from intracerebral hemorrhage (ICH) with ventricular hemorrhage (IVH), the IVH severity is thought to be associated with prognosis. Therefore, treating IVH may be a beneficial therapeutic target. In this study, by examining the associations among IVH severity, hydrocephalus, initial level of consciousness and prognosis, we attempted to identify which grade of IVH severity should be considered for surgical treatment.
  
  
  METHODS
  One hundred twenty-nine patients with spontaneous supratentorial ICH treated in our hospital between 2005 and 2006 were screened in this study. Of these patients, 100 with an ICH volume less than 60 ml were categorized into either the ICH patients without IVH (no-IVH) group (n=65) or the ICH patients with IVH (IVH) group (n=35). The Karnofsky Performance Status (KPS) scale assessed at the time of discharge was employed as an outcome index, and a KPS score of <or=40 was defined as the bedridden state. Age, gender, hemorrhage location, volume of ICH, IVH grade (according to the Graeb score), acute hydrocephalus, surgical ICH removal, and ventricular drainage were selected for univariate analyses with logistic regression.
  
  
  RESULTS
  Elderly patients, IVH volume, acute hydrocephalus, and poor initial level of consciousness were significantly associated with an unfavorable prognosis in the IVH group. Poor level of consciousness was significantly dependent on acute hydrocephalus, and significantly more occurrences of acute hydrocephalus were found in patients with a high IVH volume (Graeb score >or=6) than in patients with low to moderate IVH volume (Graeb score <or=6).
  
  
  CONCLUSIONS
  IVH severity influenced the occurrence of acute hydrocephalus and initial level of consciousness, which was significantly associated with prognosis. Our results suggest that priority treatment of the IVH should be given to those ICH patients with IVH admitted with a Graeb score of 6 or more.
authors.affiliation: Department of Neurosurgery, Kishiwada City Hospital, Kishiwada, Osaka, Japan. tom@nishikawa.org
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Nishikawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ueba
authors.forename: Motohiro
authors.initials: M
authors.lastname: Kajiwara
authors.forename: Naomi
authors.initials: N
authors.lastname: Miyamatsu
authors.forename: Kohsuke
authors.initials: K
authors.lastname: Yamashita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D002552:Cerebral Ventricles / Q000601:surgery; D004322:Drainage; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000601:surgery; D020300:Intracranial Hemorrhages / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011379:Prognosis; D016896:Treatment Outcome