Intra-Ventricular Hemorrhage (IVH)

An accumulation of blood within the ventricular system that may occur spontaneously (from hypertension, blood thinners), from tumors or vascular malformations or as a result of a surgical intervention. IVH may obstruct the normal flow and reabsorption of cerebrospinal fluid and cause hydrocephalus. Treatments include external ventricular drainage, ventriculo-peritoneal shunting, and instillation of the potent blood thinner Tissue Plasminogen Activator (TPA) directly into the ventricular system (Figure 1, 2). Over time the coagulum is metabolized by the body; an assessment of the status of CSF reabsorption is then undertaken to anticipate symptomatic hydrocephalus.

Figure 1
Top row: Axial CT demonstrates an extensive intraventricular and subarachnoid hemorrhage on day of admission with associated hydrocephalus. Bottom row: Demonstrates near complete resolution of IVH after four doses of intrathecal tissue plasminogen activator (TPA).

Figure 2
Images obtained before and after treatment of intraventricular hemorrhage with EVD and intraventricular TPA.