title: The predictors and clinical impact of intraventricular hemorrhage in patients with aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Intraventricular hemorrhage is known to complicate the course and outcome of aneurysmal subarachnoid hemorrhage.
  
  
  OBJECTIVE
  To identify independent risk factors for intraventricular hemorrhage development and its severity during aneurysm rupture.
  
  
  METHODS
  Six hundred and twenty-five subarachnoid hemorrhage patients treated at our institution between January 2005 and December 2012 were included. The severity of intraventricular hemorrhage was assessed according to the original Graeb score. Clinical and radiographic features of patients present at the bleeding event were tested as potential risk factors for intraventricular hemorrhage. The characteristics of intraventricular hemorrhage were correlated with the clinical course and outcome.
  
  
  RESULTS
  Intraventricular hemorrhage was present in 206 patients (33%) and was independently predicted by patient's age (p = 0.001, odds ratio (OR) = 1.02/year of age increase), aneurysm size (p = 0.031, OR = 1.05/mm increase), and location (p < 0.0001, OR = 3.2 for aneurysms of posterior circulation). The severity of intraventricular hemorrhage was predicted by aneurysm size (p = 0.023) and location (higher severity for aneurysms of anterior circulation, p = 0.01). The presence of intraventricular hemorrhage (p < 0.0001, OR = 4.1) and intraventricular hemorrhage severity of >3 points on the Graeb score (p = 0.029, OR = 3.4) was independently associated with poor outcome. Shunt dependency was associated only with the occurrence of intraventricular hemorrhage (p < 0.0001, OR = 2.8) while the severity of intraventricular hemorrhage influenced the timing of shunt placement (p = 0.0156).
  
  
  CONCLUSIONS
  Increasing age, aneurysm size, and location in the posterior circulation are the main risk factors for occurrence of aneurysmal intraventricular hemorrhage, which is independently associated with poor outcome. The severity of intraventricular hemorrhage, however, is higher if the aneurysm is located in the anterior circulation and has impact on functional outcome, but not on shunt dependency.
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Freiburg/Breisgau, Germany Department of Neurosurgery, University Hospital Essen, Essen, Germany ramazan.jabbarli@uniklinik-freiburg.de.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Jabbarli
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Freiburg/Breisgau, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Reinhard
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Freiburg/Breisgau, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Roelz
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Freiburg/Breisgau, Germany.
authors.forename: Mukesch
authors.initials: M
authors.lastname: Shah
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Freiburg/Breisgau, Germany.
authors.forename: Wolf-Dirk
authors.initials: WD
authors.lastname: Niesen
authors.affiliation: Institute for Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg/Breisgau, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kaier
authors.affiliation: Department of Neuroradiology, University Medical Center Freiburg, Freiburg/Breisgau, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Taschner
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Freiburg/Breisgau, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Weyerbrock
authors.affiliation: Department of Neurosurgery, University Medical Center Freiburg, Freiburg/Breisgau, Germany.
authors.forename: Vera Van
authors.initials: VV
authors.lastname: Velthoven
mesh_terms: D000367:Age Factors; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
keywords: Intraventricular hemorrhage; aneurysm rupture; outcome; predictor; shunt dependency; subarachnoid hemorrhage