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Prognostic significance of third ventricle blood volume in intracerebral haemorrhage with severe ventricular involvement
  1. Dimitre Staykov1,
  2. Bastian Volbers1,
  3. Ingrid Wagner1,
  4. Hagen B Huttner1,
  5. Arnd Doerfler2,
  6. Stefan Schwab1,
  7. Juergen Bardutzky1,3
  1. 1Department of Neurology, University of Erlangen, Erlangen, Germany
  2. 2Department of Neuroradiology, University of Erlangen, Erlangen, Germany
  3. 3Department of Neurology, University of Freiburg, Freiburg, Germany
  1. Correspondence to Dr D Staykov, Department of Neurology, University of Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany; dimitre.staykov{at}


Background and purpose Intraventricular haemorrhage (IVH) is an independent predictor of poor outcome in spontaneous intracerebral haemorrhage (ICH). Larger IVH volume and increasing number of affected ventricles have been associated with worse prognosis, however, little is known about the prognostic value of blood volume in the different parts of the ventricular system. Therefore, the correlation of IVH volume in the third, fourth and lateral ventricles with outcome in patients with ICH and severe IVH, treated with intraventricular fibrinolysis (IVF), was investigated.

Methods Patients with ICH <40 ml, severe IVH and acute hydrocephalus were treated with IVF. The course of IVH volume for each ventricle was measured by CT based volumetry. Outcome at 90 days was assessed by a telephone follow-up survey and correlated with initial IVH volume.

Results 50 patients aged 62.5±10.3 years with spontaneous ICH (12.5±10.8 ml) and severe IVH (33.5±25 ml) were included. Clearance of the third and fourth ventricle from blood occurred after 3±1.9 days. Initial IVH volume in the third ventricle (3.8±3.3 ml) was predictive for poor outcome (OR 2.6 per ml, p=0.02). Correlation between larger IVH volume in the fourth ventricle and poor outcome showed a trend towards significance (p=0.07). Total IVH volume and lateral ventricle IVH volume were not correlated with outcome.

Conclusion Despite rapid clot removal, initial IVH volume in the third ventricle was a strong and independent negative predictor. This is possibly explained by irreversible damage of brainstem structures by the initial mass effect of IVH.

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the ethics committee of Erlangen, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.