外伤性脑室内出血1例报告

男,24岁,因“骑乘摩托车摔倒、头颅受力致伤30min”入院。查体：脉搏124次/min,呼吸32次/min,血压90/60mmHg。重度昏迷,极度烦躁,查体不合作,GCS6分。颜面部散在血渍,频繁呕吐,呕吐物为暗红色血性,双鼻腔亦有血性分泌物溢出,呼吸急促且困难,典型“三凹征”。右眼角外上方擦挫裂伤,长4cm,右瞳散大7mm且固定,光反射消失,左瞳扩大5mm,光反射迟钝。颈项强直四指,双肺呼吸音粗糙且广泛散在哮鸣者、罗音,痰鸣严重,心音遥远。     

拔除脑室-腹腔分流管致脑室内出血2例报告及文献复习

目的探讨拔除脑室-腹腔分流管致脑室内出血的原因、预防措施及处理方法。方法回顾性分析我院2例脑室-腹腔分流管拔除术后脑室内出血患者的临床资料,并结合相关文献进行分析。结果 1例出血量较大,再次经纵裂-胼胝体入路手术止血、清除血肿并灼烧脉络丛,恢复良好;1例出血量较小,直接行VPS,术后1周分流管腹腔端出现阻塞,再次手术调整后恢复良好。结论包绕脑室端分流管的新生血管断裂是拔除脑室-腹腔分流管致脑室内出血的主要原因。减少脑室-腹腔分流术后并发症的发生,利用神经内镜处理脑室端分流管可能是预防脑室内出血有效措施,及时止血、清理血肿、烧灼脉络丛是改善预后的重要处理方法。     

尿激酶脑室内灌注治疗脑室内出血50例报告

脑室内出血（ＩＶＨ）是一种较常见急性出血性脑血管病,既往传统内科保守治疗,死亡率高。自ＣＴ应用临床以后,早期诊断、早期治疗,室灌注持续外引流,取得较满意,效果报告如下：临床资料１．一般资料及临床表现：本组５０例,男３４例,女１６例,年龄２２～７２岁,...     

62例成年人自发性脑室内出血手术治疗的分析

我们对62例自发性脑室内出血(IVH)患者，经不同的手术方式治疗，取得较好效果，现报告如下。     

外伤性脑室内出血

外伤性脑室内出血IVH常伴有严重的脑损伤,预后差,死亡率高。本文复习文献,对外伤性IVH的有关问题进行了综述。     

尿激酶引流术治疗脑室内出血46例临床观察

脑室内出血是指由非外伤因素导致颅内血管破裂，血液进入脑室系统引起的综合征。其发病率很高，约占自发性颅内出血的20％-60％。脑室内出血分为原发性和继发性脑室内出血两类，常见的病因为高血压、动脉硬化、颅内动脉瘤、脑动静脉畸形、烟雾病等。脑室内出血是一种自然病程长、预后差、死亡率和病残率较高的脑出血性急症。我科自1998-01～2004—05，采用脑室外引流结合尿激酶治疗脑出血46例，获得满意疗效，现报告如下。     

脑室内出血122例临床分析

目的：对脑室内出血的原因，临床表现及治疗，预后做初步的分析。方法：对我院1999－2001年以来收治的脑室内出血122例的治疗情况做回顾性的分析。结果：死亡48例占全部病例的39．3％，生活自理20例，需人照顾22例，恢复良好32例。其预后相当不乐观。结论：脑室出血的原因多数是高血压占38．5％，其次为动静脑畸形，烟雾病、动脉瘤、外伤，部分病因不清，治疗以脑室外流，如尿激酶灌注，脑脊液置换等方法为主，预后不佳，尤其是年龄越大、预后愈差，昏迷越深预后越差，发病早期脑室扩大，说明已形成梗阻性脑积水，它是导致病人急性恶化和死亡的主要因素。此外，出血部位和伴有脑实质内血肿量的大小，都影响预后的程度。     

脑室外联合腰大池引流治疗脑室出血并发脑积水

目的总结脑室外联合腰大池引流治疗脑室出血并发脑积水的疗效。方法回顾性分析45例脑室出血并发脑积水病人的临床资料,其中采取脑室外联合腰大池引流(联合组)16例,采取单纯脑室外引流(单纯组)29例。对两组因脑积水需行脑室-腹腔分流术的病例进行统计分析。结果联合组腰大池引流时间5～25d,平均12d;脑室外引流时间4～18d,平均12d。单纯组引流时间8～24d,平均16d。术后并发颅内感染,联合组1例(6.3%),单纯组3例(10.3%);引流管堵塞或脱落,联合组和单纯组各2例。术后需行脑室-腹腔分流术,联合组3例(18.7%),单纯组10例(34.5%),两组比较差异具有统计学意义(P0.05)。结论早期脑室外联合腰大池引流是治疗脑室出血并发脑积水安全而有效的措施。     

脑室内出血引流术后脑室炎的治疗

侧脑室穿刺引流术是治疗脑室内出血最常用的方法．临床常同时大量采用脑室内注入尿激酶促血肿溶解．以清除脑室内血肿．解除急性梗阻性脑积水．降低颅内压力，同时监测脑出血急性期颅内压力。但术后由于各种原因导致脑室炎发生率较高，脑原发疾病及继发中枢系统感染使病人预后凶险。现将我院引流术后脑室炎的治疗经验分析如下。     

58例高血压脑室内出血治疗体会

1．一般资料：男37例，女21例。年龄34—68岁，平均55．4岁。全部病人均有高血压病史，第一次出血。原发性脑室内出血2例，侧脑室额角、体部各1例；继发性脑室内出血56例，基底节区出血26例，丘脑出血27例，颞叶出血3例，血肿量60ml以上3例，30—60ml27例，30ml以下26例，所有病例三、四脑室、双侧脑室均有积血，按Verma评分分级标准10分2例，9分1例，8分4例，7分6例，6分11例，5分29例，4分5例。     

脑室内肿瘤合并脑积水的神经内镜治疗

目的探讨神经内镜手术治疗脑室内肿瘤合并脑积水的方法与技巧。方法回顾性分析10例脑室内肿瘤合并脑积水的临床资料,其中肿瘤位于侧脑室5例,第三脑室4例,脑室内多发肿瘤1例。均在神经导航指引下行内镜手术,同时行第三脑室造瘘术9例,透明隔造瘘术1例。结果肿瘤全切除8例,次全切除1例,仅行活检1例。术后颅高压症状均缓解,发现不同程度发热3例,无癫间疒发作及其他严重并发症。术后脑脊液磁共振电影成像(Cine MRI)显示所有病人脑脊液循环动力学均不同程度改善。随访3～24个月,平均10.6个月,死亡1例,无肿瘤复发;复查MRI显示脑室体积轻度缩小2例,无明显变化8例。结论神经内镜手术既可切除肿瘤,又能重建脑脊液循环,可作为脑室内肿瘤合并脑积水的首选治疗方法。应根据脑室形态和肿瘤位置、大小、性质等在导航引导下选择个体化的手术入路切除肿瘤。     

Cerebral vasospasm associated with intraventricular hemorrhage

Background and Purpose: Cerebral vasospasm remains a major complication associated with aneurysmal subarachnoid hemorrhage. Although several case reports have demonstrated that intraventricular hemorrhage (IVH) related to a ruptured arteriovenous malformation can result in vasospasm in the absence of subarachnoid hemorrhage, to our knowledge, this is the first case report of cerebral vasospasm associated with primary IVH. Case Report: A 44-year-old female was admitted with cerebellar infarction secondary to left posteroinferior cerebellar artery occlusion. Her hospital stay was complicated by primary IVH. Three days after her IVH, she became disoriented and developed a peculiar interest in counting numbers. This behavioral change was associated with an increase in cerebral blood flow velocity in the anterior circulation. Middle cerebral artery M1 velocity almost doubled from 65 to 130 cm/second. Her symptoms resolved with initiation of hypervolemia, hypertension, and hemodilution (triple H) therapy. Conclusions: Cerebral vasospasm may contribute to the comorbidities of IVH. Routine transcranial Doppler may be warranted for screening of cerebral vasospasm in IVH patients.     

Prognosis in solitary intraventricular haemorrhage

Isolated intraventricular haemorrhage (IVH) in the absence of parenchymal haematoma is unusual. Fifteen patients with solitary IVH among 170 with intracranial haemorrhage were studied. Clinical details and computed tomographic features were analysed to evaluate the prognostic significance of various clinical and CT parameters. Outcome is affected by hypertension, level of consciousness, clinical progression, pupillary changes and restriction of eye movements. Factors found on CT to have prognostic significance included degree of ventricular bleed, presence of cisternal bleed, hydrocephalus and cerebral atrophy.     

Intraventricular thrombolysis with rt-PA in patients with intraventricular hemorrhage

Dunatov S, Antoncic I, Bralic M, Jurjevic A. Intraventricular thrombolysis with rt‐PA in patients with intraventricular hemorrhage.
Acta Neurol Scand: 2011: 124: 343–348.
© 2011 John Wiley & Sons A/S. Objectives – To evaluate safety, clinical feasibility, and outcome of intraventricular (IVen) administration of recombinant tissue plasminogen activator (rt‐PA) in patients with intraventricular hemorrhage (IVH). Materials and methods – Forty‐eight patients with IVH who received IVen rt‐PA were compared with 49 age‐, sex‐, Glasgow Coma Scale score‐, and Intracerebral Hemorrhage score‐matched control patients. Patients with IVH of aneurysmal or arteriovenous malformation origin were excluded. External ventricular drainage was inserted as soon as baseline CT was performed and rt‐PA was administered within 12 ± 1 h after the ictal onset. Results – The outcome after 3 months was evaluated using the modified Rankin Scale (mRS). In addition, Glasgow Outcome Scale (GOS) and mortality were assessed. A good outcome, defined as mRS 0–3, was detected in 27% of patients from the control group vs 58% of patients in the IVen group; P = 0.003. GOS as other outcome scale yielded a significant difference between groups: 20% in the control group, vs 54% in the IVen group; P = 0.001. A statistically significant decrease in mortality was observed in the IVen group: 30% in the control vs 10% in IVen group; P = 0.003. No one patient died because of a complication which could be directly attributed to the IVen thrombolytic therapy. Conclusions – IVen administration of rt‐PA seems to be safe in cases of IVH. This pilot study shows that it may be associated with better outcomes. Further studies and clinical randomized trials are needed to establish indications and IVen administration protocols.     

Role of red blood cell lysis and iron in hydrocephalus after intraventricular hemorrhage

Thrombin and iron are two major players in intracerebral hemorrhage-induced brain injury and our recent study found that thrombin contributes to hydrocephalus development in a rat model of intraventricular hemorrhage (IVH). This study investigated the role of red blood cell (RBC) lysis and iron in hydrocephalus after IVH. There were three parts to this study. First, male Sprague-Dawley rats received an injection of saline, packed, or lysed RBCs into the right lateral ventricle. Second, rats had an intraventricular injection of iron or saline. Third, the rats received intraventricular injection of lysed RBCs mixed with deferoxamine (0.5 mg in 5 μL saline) or saline. All rats underwent magnetic resonance imaging at 24 hours and were then euthanized for brain edema measurement, western blot analysis, or brain histology. We found that intraventricular injection of lysed RBCs, but not packed RBCs, resulted in ventricular enlargement and marked increases in brain heme oxygenase-1 and ferritin at 24 hours. Intraventricular injection of iron also resulted in ventricular enlargement and ventricular wall damage 24 hours later. Coinjection of deferoxamine reduced lysed RBC-induced ventricular enlargement (P<0.01). These results suggest that iron, a degradation product of hemoglobin, has an important role in hydrocephalus development after IVH.     

Mechanisms and evolution of the brain damage in neonatal post-hemorrhagic hydrocephalus

There are three main mechanisms of poor outcome in children with post-hemorragic hydrocephalus: (1) brain injuries due to ventricular dilatation, (2) shunt-related complications, and (3) primary cerebral hypoxic-ischemic and hemorrhagic lesions. The authors give a short up-to-date report, focusing mainly on the third mechanism, with reference to personal studies.Presented at the Consensus Conference: Hydrocephalus '92 Assisi, Italy, 26–30 April 1992     

Primary intraventricular haemorrhage in adults

INTRODUCTION: Primary intraventricular haemorrhage (PIVH) is an uncommon type of intracerebral haemorrhage. Relatively little is known about clinical and imaging features, and even less about prognosis and predictors of mortality. MATERIAL AND METHODS: We analysed clinical and imaging features, causative factors and outcome of 26 patients with CT brain scan evidence of PIVH. A multivariate regression model of failure time data was used to assess predictors of in-hospital mortality. RESULTS: Loss of consciousness was the first manifestation of PIVH in six patients and occurred after all other symptoms in five. In other patients, onset was characterized by headache, vomiting, confusion and disorientation (n=8) or by headache with or without vomiting (n=7). Angiography revealed vascular malformations in eight patients (31%). Other possible causative factors were clotting disorder in one patient and arterial hypertension in 10. No cause was identified in seven patients. Early hydrocephalus was the most frequent complication and resolved spontaneously in a minority of patients. In-hospital mortality was high (42%): four patients died early of direct consequence of bleeding and seven died after clinical worsening because of increasing hydrocephalus or other adverse events. Multivariate analysis indicated Glasgow Coma Scale < or = 8 (OR 4.67; 95% CI 1.22-17.92) and early hydrocephalus (OR 4.93; 95% CI 1.13-21.59) as independent predictors of in-hospital mortality. CONCLUSION: In patients with PIVH, hydrocephalus seems to be a critical determinant of in-hospital mortality and this suggests the need for early treatment strategies.     

影响原发性脑室出血预后因素的研究

目的 :探讨影响原发性脑室出血预后的因素。方法 :分别从年龄、脑室积血程度、脑室内积血 CT值和GCS(Glasgow coma scale)四个方面对 36例原发性脑室出血患者死亡率的影响进行分析。结果 :通过χ2 检验和L ogistic回归分析 ,CT值≥ 6 5 Hu组死亡率显著高于 CT值 <6 5 Hu组 (P<0 .0 1) ;GCS≤ 7组死亡率高于 GCS>7组(χ2 检验 P<0 .0 5 ,L ogistic回归分析 P>0 .0 5 ) ;全脑室积血组死亡率高于部分脑室积血组 (L ogistic回归分析 P<0 .0 5 ,χ2 检验 P>0 .0 5 ) ;而不同年龄组死亡率则无影响。结论 :急性期脑室内积血的 CT值高低是影响原发性脑室出血预后的主要因素 ,其次可能是脑室内积血程度和病情轻重     

立体定向联合穿刺引流治疗脑室出血的探讨

目的探讨全脑室系统出血铸型的治疗方法,评价其治疗效果。方法36例全脑室系统出血铸型患者采用立体定向侧脑室前、后角置管引流、脑室内灌注尿激酶、生理盐水间断交替冲洗的方法进行治疗,并对手术病人进行随访。结果36例血肿消失时间分别为2d 7例,3d 15例,4d 10例,5d 4例。3个月～2年随访(ADL分级法),Ⅰ级10例,Ⅱ级12例,Ⅲ级9例,Ⅳ级5例。结论立体定向侧脑室前、后角穿刺引流治疗全脑室系统出血铸型是一种安全、有效的治疗方法．     

重组组织型纤溶酶原激活剂治疗脑室内出血

目的 探讨利用重组组织型纤溶酶原激活剂(rt-PA)脑室内给药治疗脑室出血的疗效和安全性. 方法 对自2005年11月至2007年10月收入我院的10例脑室出血患者CT确诊后,进行(单侧或双侧)脑室穿刺置管,4～6 h后经弓l流管缓慢注入rt-PA 4～8 mg,12～24 h重复1次,每24～48小时复查CT了解脑室内血肿清除情况,直至头颅CT扫描显示脑室内高密度影像消失.于脑室出血后30 d时对患者情况利用GOS评分进行评估. 结果 每个患者应用rt-PA总剂量为13～24 mg,30 d后GOS评分为良好4例,中残3例,重残2例,植物生存1例,无患者死亡,无出血、颅内感染等并发症,未发生引流管被血块堵塞情况. 结论 选择适宜剂量和方法的rt-PA脑室内给药能够加速脑室内血块溶解,保持脑室引流管通畅,减少血块占位效应.该方法能够安全有效地改善患者的预后.