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J Neurol Surg A Cent Eur Neurosurg 2015; 76(02): 126-132
DOI: 10.1055/s-0034-1394189
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Intraventricular Hemorrhage Is Associated with Early Hydrocephalus, Symptomatic Vasospasm, and Poor Outcome in Aneurysmal Subarachnoid Hemorrhage

Thomas J. Wilson
1   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
,
William R. Stetler Jr.
1   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
,
Matthew C. Davis
1   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
,
David A. Giles
1   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
,
Adam Khan
2   Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States
,
Neeraj Chaudhary
2   Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States
,
Joseph J. Gemmete
1   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
,
Guohua Xi
1   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
,
B. Gregory Thompson
1   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
,
Aditya S. Pandey
1   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
› Author Affiliations
Further Information

Publication History

16 October 2013

23 May 2014

Publication Date:
29 December 2014 (online)

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Abstract

Objective We hypothesized that the subset of patients with early hydrocephalus following aneurysmal subarachnoid hemorrhage may represent a subset of patients with a more vehement inflammatory reaction to blood products in the subarachnoid space. We thus examined risk factors for early hydrocephalus and examined the relationship between early hydrocephalus and symptomatic vasospasm as well as clinical outcome.

Methods We retrospectively analyzed all patients presenting to our institution with subarachnoid hemorrhage over a 7-year period. We examined for risk factors, including early hydrocephalus, for poor clinical outcome and symptomatic vasospasm.

Results We found intraventricular hemorrhage to be strongly associated with the development of early hydrocephalus. In univariate analysis, early hydrocephalus was strongly associated with both poor functional outcome and symptomatic vasospasm. In multivariate analysis, intraventricular hemorrhage and tobacco use were associated with symptomatic vasospasm; intraventricular hemorrhage, intraparenchymal hemorrhage, and symptomatic vasospasm were associated with poor functional outcome.

Conclusions We found that intraventricular hemorrhage was strongly associated with early hydrocephalus. Further exploration of the mechanistic explanation is needed, but we suggest this may be from a combination of obstruction of cerebrospinal fluid pathways by blood products and inflammation in the choroid plexus resulting in increased cerebrospinal fluid production. Further, we suggest that both early hydrocephalus and cerebral vasospasm may be parts of the overall inflammatory cascade that occurs with intraventricular hemorrhage and ultimately results in a poorer clinical outcome.

Keywords

aneurysm - hydrocephalus - endovascular coiling - subarachnoid - hemorrhage
 

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