Prognostic significance of third ventricle dilation in spontaneous intracerebral hemorrhage: a preliminary clinical study

Özdemir, Özgür; Calisaneller, Tarkan; Hastürk, Aşkın Esen; Aydemir, Fatih; Caner, Hakan; Altınörs, Nur

doi:10.1179/174313208x276240

Cited by 26 publications

(7 citation statements)

References 16 publications

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“…23 Interestingly, development of shuntdependent hy drocephalus was more likely in those patients with a tha lamic hemorrhage, but independent of other hemorrhage locations or IVH volume, despite the fact that IVH is known to predict worse outcomes in patients with ICH in a volumedependent manner. 18,25 Given the anatomical relationship of thalamic hemorrhages to the third ven tricle and the foramen of Monro, it is intuitive that he matoma formation in this location more easily results in obstruction of CSF flow independent of IVH volume than in hemorrhages occurring in other locations. Reports of thalamic cavernomas and hemorrhages without intraven tricular extension have documented the development of hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Zacharia¹,

Vaughan²,

Hickman³

et al. 2012

FOC

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Object Intracerebral hemorrhage (ICH) is frequently complicated by acute hydrocephalus, necessitating emergency CSF diversion with a subset of patients, ultimately requiring long-term treatment via placement of permanent ventricular shunts. It is unclear what factors may predict the need for ventricular shunt placement in this patient population. Methods The authors performed a retrospective analysis of a prospective database (ICH Outcomes Project) containing patients with nontraumatic ICH admitted to the neurological ICU at Columbia University Medical Center between January 2009 and September 2011. A multiple logistic regression model was developed to identify independent predictors of shunt-dependent hydrocephalus after ICH. The following variables were included: patient age, admission Glasgow Coma Scale score, temporal horn diameter on admission CT imaging, bicaudate index, admission ICH volume and location, intraventricular hemorrhage volume, Graeb score, LeRoux score, third or fourth ventricle hemorrhage, and intracranial pressure (ICP) and ventriculitis during hospital stay. Results Of 210 patients prospectively enrolled in the ICH Outcomes Project, 64 required emergency CSF diversion via placement of an external ventricular drain and were included in the final cohort. Thirteen of these patients underwent permanent ventricular CSF shunting prior to discharge. In univariate analysis, only thalamic hemorrhage and elevated ICP were significantly associated with the requirement for permanent CSF diversion, with p values of 0.008 and 0.033, respectively. Each remained significant in a multiple logistic regression model in which both variables were present. Conclusions Of patients with ICH requiring emergency CSF diversion, those with persistently elevated ICP and thalamic location of their hemorrhage are at increased odds of developing persistent hydrocephalus, necessitating permanent ventricular shunt placement. These factors may assist in predicting which patients will require permanent CSF diversion and could ultimately lead to improvements in the management of this disorder and the outcome in patients with ICH.

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Section: Discussionmentioning

confidence: 99%

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Zacharia¹,

Vaughan²,

Hickman³

et al. 2012

FOC

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“…A strong association of IVH in the third and fourth ventricle with poor outcome has been described previously [23,24]. It seems that both local mechanical and biochemical factors contribute to the unfavorable course.…”

Section: Discussionmentioning

confidence: 94%

Autonomic Effects of Intraventricular Extension in Intracerebral Hemorrhage

Sýkora

Steiner²,

Poli³

et al. 2011

Neurocrit Care

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“…Furthermore, blood volume in the fourth ventricle showed a trend towards influence on prognosis, while total IVH volume and IVH volume in the lateral ventricles were not associated with outcome. Involvement of the third and fourth ventricles has already been shown to be a negative prognostic predictor in ICH with IVH 3 5 6. However, a volume dependent relationship between initial ventricular haemorrhage in the third ventricle and outcome has not yet been reported.…”

Section: Discussionmentioning

confidence: 99%

“…However, little is known about the prognostic value of blood volume in the different parts of the ventricular system, particularly in the third and fourth ventricles located within the brainstem structures with high eloquence. Very few studies have investigated in detail the role of IVH with third and fourth ventricle involvement as a cause of morbidity 3 5 6. Two retrospective case series of approximately 20 patients each have suggested that dilation of the third5 and fourth6 ventricles is associated with worse outcome and high mortality in patients with IVH secondary to spontaneous ICH, especially when obstructive hydrocephalus due to casting of the aqueduct is present 7.…”

Section: Introductionmentioning

confidence: 99%

“…Very few studies have investigated in detail the role of IVH with third and fourth ventricle involvement as a cause of morbidity 3 5 6. Two retrospective case series of approximately 20 patients each have suggested that dilation of the third5 and fourth6 ventricles is associated with worse outcome and high mortality in patients with IVH secondary to spontaneous ICH, especially when obstructive hydrocephalus due to casting of the aqueduct is present 7. Another study has identified the presence of blood in the fourth ventricle as a negative prognostic predictor 3…”

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of third ventricle blood volume in intracerebral haemorrhage with severe ventricular involvement

Staykov

Volbers

Wagner

et al. 2011

Journal of Neurology, Neurosurgery & Psychiatry

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Background and purpose Intraventricular haemorrhage (IVH) is an independent predictor of poor outcome in spontaneous intracerebral haemorrhage (ICH). Larger IVH volume and increasing number of affected ventricles have been associated with worse prognosis, however, little is known about the prognostic value of blood volume in the different parts of the ventricular system. Therefore, the correlation of IVH volume in the third, fourth and lateral ventricles with outcome in patients with ICH and severe IVH, treated with intraventricular fibrinolysis (IVF), was investigated. Methods Patients with ICH <40 ml, severe IVH and acute hydrocephalus were treated with IVF. The course of IVH volume for each ventricle was measured by CT based volumetry. Outcome at 90 days was assessed by a telephone follow-up survey and correlated with initial IVH volume. Results 50 patients aged 62.5610.3 years with spontaneous ICH (12.5610.8 ml) and severe IVH (33.5625 ml) were included. Clearance of the third and fourth ventricle from blood occurred after 361.9 days. Initial IVH volume in the third ventricle (3.863.3 ml) was predictive for poor outcome (OR 2.6 per ml, p¼0.02). Correlation between larger IVH volume in the fourth ventricle and poor outcome showed a trend towards significance (p¼0.07). Total IVH volume and lateral ventricle IVH volume were not correlated with outcome. Conclusion Despite rapid clot removal, initial IVH volume in the third ventricle was a strong and independent negative predictor. This is possibly explained by irreversible damage of brainstem structures by the initial mass effect of IVH.

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Prognostic significance of third ventricle dilation in spontaneous intracerebral hemorrhage: a preliminary clinical study

Abstract: Although the roles of various factors are well described in the prognosis of spontaneous ICH, little is known about the role of third ventricle dilation. Based on our results, we concluded that third ventricle dilation is a poor prognostic factor.

Cited by 26 publications

References 16 publications

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Autonomic Effects of Intraventricular Extension in Intracerebral Hemorrhage

Prognostic significance of third ventricle blood volume in intracerebral haemorrhage with severe ventricular involvement

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