Cerebral Vasospasm and Delayed Cerebral Ischemia in Intraventricular Hemorrhage

Abstract

Cerebral vasospasm seems to be a frequent complication after ICH with IVH and might be associated with DCI. Larger studies are warranted to confirm this hypothesis.

Computed tomography interobserver agreement in the assessment of aneurysmal subarachnoid hemorrhage and predictors for clinical outcome

“…More recent evidence suggests that IVH independently increases DCI risk, and subsequent grading systems have adopted this feature as a distinguishing criterion 7 9 11 12. The mechanism for this association is unknown, but it has been hypothesized that the gradual recirculation of heme products from an intraventricular clot into the subarachnoid space is one possible cause for protracted secondary brain injury 31 32. Second, the designation of Fisher grade 3 SAH also fails to account for incremental increases in DCI risk in accordance with clot thickness within this high risk group 13.…”

Delayed Cerebral Ischemia of the Corpus Callosum: A Case Report

“…Patients suffering from IVH, although distinct from SAH, have been shown to carry a similar predisposition to DCI as SAH patients, with several studies reporting the incidence of secondary cerebral infarctions following either primary or secondary IVH [2,12,13,14]. The presence of DCI in both SAH and IVH patients is hypothesized to be because both SAH and IVH patients have blood and blood degradation products distributing to the subarachnoid space, with the severity of IVH correlated with an increased risk of DCI [2,15]. This hypothesis is supported in the literature, particularly in a study by Claassen et al (2001) that investigated the risk factors and predispositions of DCI development in 276 SAH patients with and without IVH and/or ICH.…”

Influence of Bleeding Pattern on Ischemic Lesions After Spontaneous Hypertensive Intracerebral Hemorrhage with Intraventricular Hemorrhage

“…Redistribution of blood to the subarachnoid space from the ventricular compartment may cause cerebral vasospasm and delayed cerebral ischemia and has been reported in several case reports with isolated IVH. 9, 13–17 Ischemic lesions occurred at a median of 10 days after IVH/ICH in CLEAR III. Despite reliance on CT scans to diagnose these lesions and inherent delays in visualization, the apparent delay in lesion onset also supports a possible hypothesis of blood redistribution to the subarachnoid space over the first few days after hemorrhage onset causing delayed cerebral vasospasm which may have resulted in ischemic lesions in the subacute phase.…”