title: Inflammatory response to intraventricular hemorrhage: time course, magnitude and effect of t-PA.
abstract: BACKGROUND
  In 45% of cases of intracerebral hemorrhage (ICH) the hematoma extends into the ventricles (IVH). Intraventricular inflammation may be one mechanism by which IVH exerts deleterious effects. Tissue plasminogen activator instillation into the ventricles (IVT) has been studied for the treatment of IVH; however, its effect on IVH-induced inflammation is unknown. The purpose of this work was to describe the inflammatory response in the CSF following IVH and compare it in patients treated or not treated with IVT.
  
  
  METHODS
  Consecutive patients diagnosed with IVH and treated with ventriculostomy were selected from our prospective stroke registry from November 2004 to July 2007. CSF protein, glucose, and WBC (corrected for RBC number) from samples collected up to 19 days after IVH were captured. Patients with evidence of CSF infection were excluded.
  
  
  RESULTS
  29 patients were identified: 18 in the IVT group and 11 in the non-IVT group. The two groups were comparable in terms of stroke severity and IVH volume. A brisk cellular inflammatory reaction developed around day 2, lasted 5 days and then subsided. IVT seemed to attenuate this response. There were no differences in clinical outcomes between groups.
  
  
  CONCLUSIONS
  IVH induces intrathecal inflammatory response that peaks at day 5. IVT appears to modify this inflammation. Further work is needed to study the relationship between the intraventricular inflammatory response and patient outcome.
authors: Neurology Department and Stroke Unit, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, Israel. hen.hallevi@gmail.com
authors: Hen
authors: H
authors: Hallevi
authors: Kyle C
authors: KC
authors: Walker
authors: Mallikarjunarao
authors: M
authors: Kasam
authors: Natan
authors: N
authors: Bornstein
authors: James C
authors: JC
authors: Grotta
authors: Sean I
authors: SI
authors: Savitz
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002552:Cerebral Ventricles / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000008:administration & dosage* / Q000009:adverse effects / Q000134:cerebrospinal fluid; D057967:Infusions, Intraventricular; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D018836:Inflammation Mediators; D010959:Tissue Plasminogen Activator