title: No exacerbation of perihematomal edema with intraventricular tissue plasminogen activator in patients with spontaneous intraventricular hemorrhage.
abstract: BACKGROUND
  In severe spontaneous intraventricular hemorrhage (IVH), intraventricular (IVR) administration of tissue plasminogen activator (rtPA) clears blood from the ventricles more rapidly than with external ventricular drainage (EVD) alone. However, experimental studies suggest tPA may be neurotoxic in compromised brain tissue and may exacerbate perihematomal edema.
  
  
  METHODS
  We used computerized volumetrics to assess change in intracerebral hemorrhage (ICH), IVH, ventricular, and perihematomal edema (PHE) volumes at 2-4 (T1) and 5-9 (T2) days following diagnostic CT scans (T0) of 24 patients (12 tPA-treated; 12 controls) with IVH requiring EVD. Controls from a hospital registry were matched by IVH and ICH volume to tPA-treated patients who came from a multicenter trial involving 52 patients with IVH.
  
  
  RESULTS
  There were no significant differences between matched pairs in admission ICH and IVH volumes. IVR tPA resulted in more rapid clearance of IVH as determined by T2-T0 decrease in median IVH volume (tPA: -18.7 cc, iqr 14.9; control:-6.9 cc, iqr 6.4; P = 0.002). Median ratios of PHE to ICH volume were not significantly different in control versus tPA-treated patients at T1 and T2 [control:tPA = 0.55:0.56 (T1); P = 0.84 and 0.81:0.71 (T2); P = 1.00]. Total ventricular volume was significantly larger in the control group at T2 (mean: 57.57 ± 10.32 vs. tPA: 24.80 ± 2.67 cc; P = 0.01). Bacterial ventriculitis was more frequent in the control group (5 vs. 1 episodes; P = 0.06) as was shunt dependence (4 vs. 0 cases; P = 0.03).
  
  
  CONCLUSIONS
  For case matched large IVH with small ICH volume, IVR tPA enhances lysis of intraventricular blood clots and has no significant impact on PHE.
authors: Division of Neurosciences Critical Care, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. weziai@jhmi.edu
authors: Wendy
authors: W
authors: Ziai
authors: Tom
authors: T
authors: Moullaali
authors: Saman
authors: S
authors: Nekoovaght-Tak
authors: Natalie
authors: N
authors: Ullman
authors: Jay S
authors: JS
authors: Brooks
authors: Timothy C
authors: TC
authors: Morgan
authors: Daniel F
authors: DF
authors: Hanley
mesh_terms: D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002552:Cerebral Ventricles; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007276:Injections, Intraventricular; D008297:Male; D008875:Middle Aged; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator