Fibrinolytic Treatment of Intraventricular Hemorrhage

Abstract

Objective: To present the technique and outcome of fibrinolysis and drainage of intraventricular hematoma (IVH) in a series of 5 patients.

Methods: Recombinant tissue plasminogen activator (r-tPA) was administered twice daily through a catheter placed stereotactically in five patients. Five patients had spontaneous hypertensive intraparenchymal bleeding with large intraventricular extension. Hemorrhage was not aspirated but allowed to drain spontaneously 30 minutes after administration of r-tPA. Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS) scores were recorded, neurological examination and computerized tomography (CT) scans were performed in every 12 hours. Extended Glasgow Outcome Scale (GOSE) and mRS scores were recorded at discharge and at six months. Hematoma volumes were measured.

Results: There were 3 male and 2 female patients with a mean age of 64. Mean GCS score was 12.2, and mean mRS score was 3.8 on admission. Four patients had hemorrhage in all ventricles. Average initial intraventricular hematoma volume was 24.5 cc and average intracerebral hematoma volume was 8.4 cc. Two mg r-tPA was administered 4 times in 2 patients, 2 times in 2 patients and once in 1 patient. Clot volume reductions of 32 %, 61 %, 67 %, 78 % and 93 % were observed respectively on CTs performed at 12 hours, 24 hours, 48 hours, 72 hours and 7 days. On discharge, mean GOSE score was 5.6 and mean mRS score was 2.8. There were no surgical complication and mortality. At six months, mean GOSE score was 7 and mRS score was 0.8.

Conclusion: The results of this evaluation suggests that fibrinolysis and drainage of IVH is efficient and safe, and may lead to improved results.