Friday, April 11, 2014

Lone Intraventricular Hemorrhage and Intraventricular Hemorrhage Associated with Small Parenchymal Component: Two Different Clinical Entities (P5.135)

Lone Intraventricular Hemorrhage and Intraventricular Hemorrhage Associated with Small Parenchymal Component: Two Different Clinical Entities (P5.135)
Neurology recent issues

OBJECTIVE: To determine if the two types of intraventricular hemorrhage (IVH) have key differences in their clinical, diagnostic and prognostic profiles.BACKGROUND: Primary IVH is a rare type of intracerebral hemorrhage (ICH). The literature describes two types: 1) blood restricted to the ventricular system only 2) predominant IVH plus a small parenchymal component.DESIGN/METHODS: A retrospective chart review was performed for all the ICH patients admitted to our institution from 2008 to 2012. Radiology reports of initial CT scans were reviewed to capture patients, their images reviewed and classified into 1) lone IVH, 2) IVH with small intraparenchymal hemorrhage within 15mm of the ventricular wall (IVH/sICH) and 3) IVH with larger intraparenchymal hemorrhage within 15-30mm of ventricular wall (IVH/LICH). Exclusion criteria included subarachnoid hemorrhage and trauma.RESULTS: Out of 1178 ICH patients, 33 patients (2.8%) had lone IVH and 23 (2%) had IVH/sICH. 23 patients were randomly selected from a larger pool with IVH/LICH. Median ages were 73, 64 and 63 years. IVH/sICH was very similar to IVH/LICH in terms of clinical presentation, diagnostic workup and early clinical outcomes. When comparing lone IVH with IVH/sICH group, IVH/sICH was found to have significantly higher rate of focal findings on presentation (p<0.01), past history of hypertension (HTN) (p=0.03) and higher median systolic blood pressure on admission (p=0.02). Lone IVH patients had a higher diagnostic yield from vessel imaging studies (44.4% vs 15.4%, p=0.09), received a higher rate of cerebral angiogram performance (54.5% vs 34.8%, p=0.14) and more frequent etiology of arteriovenous malformations or arteriovenous fistula (27.3% vs 4.3%, p=0.04). Lone IVH had a trend towards better early clinical outcomes measured by median modified Rankin score at discharge (4 vs 5, p=0.08) and lower in-hospital mortality (3% vs 21.7%, p=0.07)CONCLUSIONS: Compared to IVH with small parenchymal component, lone IVH is less commonly associated with HTN, a more frequent diagnosis of vascular malformation, and with better early clinical outcomes

Disclosure: Dr. Taqui has nothing to disclose. Dr. Koffman has nothing to disclose. Dr. Hussain has nothing to disclose. Dr. Uchino has nothing to disclose.



Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P5.135?rss=1

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