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.

Aims

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.

Keywords

Intraventricular hemorrhage predictor aneurysm rupture subarachnoid hemorrhage outcome shunt dependency

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References

Rosen

Macdonald

Huo

. Intraventricular hemorrhage from ruptured aneurysm: clinical characteristics, complications, and outcomes in a large, prospective, multicenter study population. J Neurosurg 2007; 107: 261–265.

Czorlich

Ricklefs

Reitz

. Impact of intraventricular hemorrhage measured by Graeb and LeRoux score on case fatality risk and chronic hydrocephalus in aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2015; 157: 409–415.

Kramer

Mikolaenko

Deis

. Intraventricular hemorrhage volume predicts poor outcomes but not delayed ischemic neurological deficits among patients with ruptured cerebral aneurysms. Neurosurgery 2010; 67: 1044–1052. discussion 52–53.

Mayfrank

Hütter

Kohorst

. Influence of intraventricular hemorrhage on outcome after rupture of intracranial aneurysm. Neurosurg Rev 2001; 24: 185–191.

Jabbarli

Reinhard

Niesen

. Predictors and impact of early cerebral infarction after aneurysmal subarachnoid hemorrhage. Eur J Neurol 2015; 22: 941–947.

Jabbarli

Glasker

Weber

Taschner

Olschewski

Van Velthoven

. Predictors of severity of cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2013; 22: 1332–1339.

Hunt

Hess

. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28: 14–20.

van Swieten

Koudstaal

Visser

Schouten

van Gijn

. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19: 604–607.

Fisher

Kistler

Davis

. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980; 6: 1–9.

10.

Graeb

Robertson

Lapointe

Nugent

Harrison

. Computed tomographic diagnosis of intraventricular hemorrhage. Etiol Prognosis Radiol 1982; 143: 91–96.

11.

Hayashi

Handa

Kobayashi

Kawano

Nozaki

Noguchi

. Prognosis of intraventricular hemorrhage due to rupture of intracranial aneurysm. Zentralbl Neurochir 1989; 50: 132–137.

12.

Nakagawa

Suga

Mayanagi

. Predicting the overall management outcome in patients with a subarachnoid hemorrhage accompanied by a massive intracerebral or full-packed intraventricular hemorrhage: a 15-year retrospective study. Surg Neurol 2005; 63: 329–334. ; discussion 34–35.

13.

Zacharia

Vaughan

Hickman

. Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion. Neurosurg Focus 2012; 32: E5.

14.

Morgan

Dawson

Spengler

. The Modified Graeb Score: an enhanced tool for intraventricular hemorrhage measurement and prediction of functional outcome. Stroke 2013; 44: 635–641.

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