title: Intraventricular hemorrhage is associated with early hydrocephalus, symptomatic vasospasm, and poor outcome in aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  We hypothesized that the subset of patients with early hydrocephalus following aneurysmal subarachnoid hemorrhage may represent a subset of patients with a more vehement inflammatory reaction to blood products in the subarachnoid space. We thus examined risk factors for early hydrocephalus and examined the relationship between early hydrocephalus and symptomatic vasospasm as well as clinical outcome.
  
  
  METHODS
  We retrospectively analyzed all patients presenting to our institution with subarachnoid hemorrhage over a 7-year period. We examined for risk factors, including early hydrocephalus, for poor clinical outcome and symptomatic vasospasm.
  
  
  RESULTS
  We found intraventricular hemorrhage to be strongly associated with the development of early hydrocephalus. In univariate analysis, early hydrocephalus was strongly associated with both poor functional outcome and symptomatic vasospasm. In multivariate analysis, intraventricular hemorrhage and tobacco use were associated with symptomatic vasospasm; intraventricular hemorrhage, intraparenchymal hemorrhage, and symptomatic vasospasm were associated with poor functional outcome.
  
  
  CONCLUSIONS
  We found that intraventricular hemorrhage was strongly associated with early hydrocephalus. Further exploration of the mechanistic explanation is needed, but we suggest this may be from a combination of obstruction of cerebrospinal fluid pathways by blood products and inflammation in the choroid plexus resulting in increased cerebrospinal fluid production. Further, we suggest that both early hydrocephalus and cerebral vasospasm may be parts of the overall inflammatory cascade that occurs with intraventricular hemorrhage and ultimately results in a poorer clinical outcome.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wilson
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States.
authors.forename: William R
authors.initials: WR
authors.lastname: Stetler
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Davis
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States.
authors.forename: David A
authors.initials: DA
authors.lastname: Giles
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States.
authors.forename: Adam
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chaudhary
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States.
authors.forename: Guohua
authors.initials: G
authors.lastname: Xi
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States.
authors.forename: B Gregory
authors.initials: BG
authors.lastname: Thompson
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States.
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000601:surgery; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology*