Impact of intraventricular hemorrhage upon intracerebral hematoma expansion.
BACKGROUND
The purpose of this study is to determine whether intraventricular hemorrhage (IVH) exerts a "decompressive" effect that limits intracerebral hemorrhage (ICH) enlargement.


METHODS
Retrospective review of patients with spontaneous supratentorial ICH diagnosed within 6 h of onset, who underwent follow-up head CT approximately 48 h later. Digital imaging analysis of CT scans was performed to compare hematoma volume changes between patients with and without IVH. Hemorrhage locations were classified as paraventricular (PV) or non-PV. Regression analyses were employed to identify predictors of IVH, hematoma expansion, and mortality.


RESULTS
Of the 70 patients included 57% developed IVH, 85% of which occurred before initial CT. 71% of PV hemorrhages developed IVH, all before initial CT, and 48% of non-PV hemorrhages developed IVH, 29% of which occurred after initial CT. IVH was associated with PV location (P = 0.04), and among IVH patients PV location was associated with early IVH (P = 0.003). Predictors of mortality included age (P = 0.037), initial hematoma volume (P < 0.04), absolute volume change (P = 0.01), and final hematoma volume (P < 0.001). Variables predicting IVH included PV location (P < 0.0001), larger initial hematoma volume (P = 0.002), and greater absolute volume increase (P = 0.01). Hematoma expansion was greatest for non-PV with IVH (P = 0.08), and graphic inspection suggested that ICH volume tended to decrease with PV location and increase with IVH. Final hematoma volume was associated with initial volume (P < 0.0001), non-PV location (P = 0.02), and IVH (P = 0.04).


CONCLUSIONS
IVH was not associated with less hematoma volume expansion, and for non-PV hemorrhages IVH was linked to greater volume increase.
Moussouttas
Michael
M
Division of Cerebrovascular and Neurocritical Care, Thomas Jefferson Medical Center, Philadelphia, PA 19107, USA. arista1@pol.net
Malhotra
Rishi
R
Fernandez
Luis
L
Maltenfort
Mitchell
M
Holowecki
Melissa
M
Delgado
Jennifer
J
Lawson
Nadine
N
Badjatia
Neeraj
N
D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D002552:Cerebral Ventricles / Q000503:physiopathology*; D003422:Critical Care; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed