Delayed intraventricular hemorrhage is common and worsens outcomes in intracerebral hemorrhage
Delayed intraventricular hemorrhage is common and worsens outcomes in intracerebral hemorrhage
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DOI：
10.1212/wnl.0b013e31828ab2a7
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发表时间：
2013-04-01
期刊：
影响因子：
9.9
通讯作者：
Naidech, Andrew M.
中科院分区：
文献类型：
--
作者：
Maas, Matthew B.;Nemeth, Alexander J.;Naidech, Andrew M.
目的：评价迟发性脑室内出血(DIVH)的发生率、特点和临床后果。方法：对2006年12月至2012年2月间收治的原发性脑出血患者进行前瞻性登记。根据结构化的方案，对患者进行管理，并进行系列神经成像。最初和延迟的IVH在影像上以及脑出血体积上被识别，结果是盲目的。结果：共有216名患者接受了研究，其中104人(48%)在首次影像检查时已经发生了脑室内出血。在112例未发生IVH的患者中，23例(21%)随后发生IVH。在这23例中，有10例(43%)在发现dIVH后需要紧急手术干预，主要是脑室造口。在调整了脑出血评分和血肿增长的所有因素的多变量模型中，dIVH是14天死亡的独立预测因素(p=0.015)，以及3个月时更高的改良Rankin评分(均p=0.037)。在调整了单变量分析中所有其他显着变量的二次分析中，DIVH的效果仍然显著。结论：与血肿扩大类似，DIVH与死亡和不良预后独立相关。由于IVH很容易通过连续的神经成像被发现，并且通常需要紧急手术干预，因此建议监测DIVH。神经病学(R)2013；80：1295-1299
Objective: To evaluate the incidence, characteristics, and clinical consequences of delayed intraventricular hemorrhage (dIVH).Methods: Patients with primary intracerebral hemorrhage (ICH) were enrolled into a prospective registry between December 2006 and February 2012. Patients were managed, and serial neuroimaging obtained, per a structured protocol. Initial and delayed IVH were identified on imaging, along with ICH volumes, with outcomes blinded. Multivariate models were developed to test whether the occurrence of dIVH was a predictor of functional outcomes independent of known predictors, including the ICH score elements and ICH growth.Results: A total of 216 patients were studied, and 104 (48%) had IVH on initial imaging. Of the 112 with no IVH, 23 (21%) subsequently developed IVH. Emergent surgical intervention, mostly ventriculostomy placement, was required after discovery of dIVH in 10 (43%) of these 23. In multivariate models adjusting for all elements of the ICH score and hematoma growth, dIVH was an independent predictor of death at 14 days (p = 0.015) and higher modified Rankin Scale scores at 3 months (all p = 0.037). The effect of dIVH remained significant in a secondary analysis that adjusted for all other variables significant in the univariate analysis.Conclusions: Similar to hematoma expansion dIVH is independently associated with death and poor outcomes. Because IVH is easily detected by serial neuroimaging and often requires emergent surgical intervention, monitoring for dIVH is recommended. Neurology (R) 2013;80:1295-1299