title: Prognostic significance of third ventricle blood volume in intracerebral haemorrhage with severe ventricular involvement.
abstract: OBJECTIVE
  Intraventricular haemorrhage (IVH) is an independent predictor of poor outcome in spontaneous intracerebral haemorrhage (ICH). Larger IVH volume and increasing number of affected ventricles have been associated with worse prognosis, however, little is known about the prognostic value of blood volume in the different parts of the ventricular system. Therefore, the correlation of IVH volume in the third, fourth and lateral ventricles with outcome in patients with ICH and severe IVH, treated with intraventricular fibrinolysis (IVF), was investigated.
  
  
  METHODS
  Patients with ICH <40 ml, severe IVH and acute hydrocephalus were treated with IVF. The course of IVH volume for each ventricle was measured by CT based volumetry. Outcome at 90 days was assessed by a telephone follow-up survey and correlated with initial IVH volume.
  
  
  RESULTS
  50 patients aged 62.5±10.3 years with spontaneous ICH (12.5±10.8 ml) and severe IVH (33.5±25 ml) were included. Clearance of the third and fourth ventricle from blood occurred after 3±1.9&emsp14;days. Initial IVH volume in the third ventricle (3.8±3.3 ml) was predictive for poor outcome (OR 2.6 per ml, p=0.02). Correlation between larger IVH volume in the fourth ventricle and poor outcome showed a trend towards significance (p=0.07). Total IVH volume and lateral ventricle IVH volume were not correlated with outcome.
  
  
  CONCLUSIONS
  Despite rapid clot removal, initial IVH volume in the third ventricle was a strong and independent negative predictor. This is possibly explained by irreversible damage of brainstem structures by the initial mass effect of IVH.
authors.affiliation: Department of Neurology, University of Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany. dimitre.staykov@uk-erlangen.de
authors.forename: Dimitre
authors.initials: D
authors.lastname: Staykov
authors.forename: Bastian
authors.initials: B
authors.lastname: Volbers
authors.forename: Ingrid
authors.initials: I
authors.lastname: Wagner
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
authors.forename: Arnd
authors.initials: A
authors.lastname: Doerfler
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.forename: Juergen
authors.initials: J
authors.lastname: Bardutzky
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D012044:Regression Analysis; D020542:Third Ventricle / Q000503:physiopathology*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator