traumatic intraventricular hemorrhage in severe blunt head trauma: a one year analysis

abstract background: high resolution ct scan has made early diagnosis of intraventricular hemorrhage (ivh) easier. posttraumatic intraventricular hemorrhage has been reported to a greater extent because of the ct scan. methods: 904 patients were admitted in the nsicu from march 2001 to march 2002 with severe closed head injury, of those only 31 patients with intraventricular hemorrhage (gcs less than 8) are reported herein and the mechanism involved is discussed. results: nine cases had intracerebral hemorrhage (contusional group), four cases in the frontal lobe, three cases in the temporal lobe and two cases in the parietal lobe. nine cases (basal ganglia hemorrhage group) had hemorrhage in basal ganglia, six in the caudate nucleus and three in the thalamus, all spreading into the ventricles. in thirteen cases the original site of hemorrhage could not be determined. in this group six cases had accompanying peri-brain stem hemorrhage (peri-brain stem hemorrhage group) and different brain stem injury signs. four cases had ivh less than 5 ml with or without minor intracranial lesions (minor intracranial lesion group). accompanying major intracranial hemorrhage was found in sixteen cases, six cases had epidural hematoma, four cases had subdural hematoma, and seven had a combination of asdh, edh and contusional prarenchymal hemorrhages, all requiring primary surgical evacuation, and seven cases had different degrees of minor abnormalities (i.e. minor epidural hemorrhage, minor subdural hemorrhage, sub-arachnoid hemorrhage, minor cortical contusions or subdural effusions which did not need surgical intervention). two cases had acute hydrocephalus and needed ventricular external drainage. conclusion: acceleration-deceleration impact along the long axis of the skull might be the possible mechanism in shearing injury to perforating vessels of the basal ganglia for early appearance of hemorrhage in the caudate nucleus and thalamus. hemorrhage in basal ganglia and brain parenchyma eventually find their way to the ventricles.