Abstract
This chapter explores the intricacies of intraventricular hemorrhage (IVH), including its various etiologies, presentations, and associated management strategies. It delves into the distinction between primary and secondary IVH, the impact of IVH on patient prognosis, and specific considerations for IVH in newborns. The chapter also covers the role of intraventricular vascular lesions and aneurysms in IVH, providing an all-encompassing understanding of this critical neurological event.
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Keywords
- Intraventricular hemorrhage
- Intraventricular hemorrhage in newborn
- Intraventricular vascular lesions
- Intraventricular cerebral cavernomas
- Aneurysms
-
1.
Intraventricular hemorrhage (IVH), etiologies, the FALSE answer is:
-
A.
Most occur because of the extension of intraparenchymal hemorrhages.
-
B.
Can result in a rupture of the aneurysm.
-
C.
SAH refluxing into the ventricles through foramina of Luschka or Magendie.
-
D.
In adults, it is an extension of subependymal hemorrhage.
-
E.
Can be associated with severe head trauma.
Intraventricular hemorrhage (IVH), etiologies, the FALSE answer is:
-
A.
Most occur because of the extension of intraparenchymal hemorrhages.
-
B.
Can result in a rupture of the aneurysm.
-
C.
SAH refluxing into the ventricles through foramina of Luschka or Magendie.
-
D.
In adults, it is an extension of subependymal hemorrhage.
-
E.
Can be associated with severe head trauma.
Answer D
-
Extension of subependymal hemorrhage into ventricles is a common type of IVH in newborns.
-
2.
Pure or isolated IVH can result from, the FALSE answer is:
-
A.
Ruptured AcommA aneurysm.
-
B.
Putaminal hemorrhages.
-
C.
Vertebral artery dissection.
-
D.
Intraventricular AVM.
-
E.
Intraventricular tumor.
Pure or isolated IVH can result from, the FALSE answer is:
-
A.
Ruptured AcommA aneurysm.
-
B.
Putaminal hemorrhages.
-
C.
Vertebral artery dissection.
-
D.
Intraventricular AVM.
-
E.
Intraventricular tumor.
Answer B
-
IVH with putaminal hemorrhages is an example of the extension of intraparenchymal hemorrhages known as secondary IVH. Primary or pure IVH is confined only to the ventricles.
-
3.
IVH with ruptured aneurysm, the FALSE answer is:
-
A.
Ruptured aneurysm accounts for ≈ 25% of IVH in adults.
-
B.
Carotid terminus aneurysms may rupture through the floor of the third ventricle.
-
C.
Carry the same prognosis of SAH without IVH.
-
D.
AcommA aneurysm can rupture through the lamina terminalis into the anterior third ventricle.
-
E.
Distal PICA aneurysms: may rupture directly into fourth ventricle through the foramen of Luschka.
IVH with ruptured aneurysm, the FALSE answer is:
-
A.
Ruptured aneurysm accounts for ≈ 25% of IVH in adults.
-
B.
Carotid terminus aneurysms may rupture through the floor of the third ventricle.
-
C.
Carry the same prognosis of SAH without IVH.
-
D.
AcommA aneurysm can rupture through the lamina terminalis into the anterior third ventricle.
-
E.
Distal PICA aneurysms: may rupture directly into fourth ventricle through the foramen of Luschka.
Answer C
-
Carry a worse prognosis (64% mortality).
-
4.
IVH, presentation, the FALSE answer is:
-
A.
Sudden onset of severe headache.
-
B.
Nausea and vomiting.
-
C.
Decreased level of consciousness.
-
D.
Seizures are very common.
-
E.
Neurological deficit.
IVH, presentation, the FALSE answer is:
-
A.
Sudden onset of severe headache.
-
B.
Nausea and vomiting.
-
C.
Decreased level of consciousness.
-
D.
Seizures are very common.
-
E.
Neurological deficit.
Answer D
-
Clinical seizures are uncommon but have been reported in IVH.
-
5.
IVH, diagnosis, the FALSE answer is:
-
A.
MRI was performed immediately in suspected IVH.
-
B.
MRI SWI is more sensitive for IVH than traditional GRE sequences.
-
C.
CTA indicated in any patient <50–60 yrs.
-
D.
MRI is more sensitive than CT to very small amounts of blood, especially in the posterior fossa.
-
E.
Routine catheter angiography in the setting of primary IVH is warranted.
IVH, diagnosis, the FALSE answer is:
-
A.
MRI was performed immediately in suspected IVH.
-
B.
MRI SWI is more sensitive for IVH than traditional GRE sequences.
-
C.
CTA indicated in any patient <50–60 yrs.
-
D.
MRI is more sensitive than CT to very small amounts of blood, especially in the posterior fossa.
-
E.
Routine catheter angiography in the setting of primary IVH is warranted.
Answer A
-
Brain MRI is not highly sensitive in the first few hours while non-contrast CT is the mainstay of acute evaluation of patients suspected with IVH showed increased density (≈ 30–80 HU).
-
6.
IVH, general management, the FALSE answer is:
-
A.
ICU admission, elevating the head of bed, analgesia, mild sedation, MANNITOL.
-
B.
Antiepileptic drug (AED) prophylaxis is controversial.
-
C.
BP control target SBP < 110 mmHg.
-
D.
Small hematomas and limited IVH usually do not need ICP treatment.
-
E.
Early intensive lowering of BP does not result in a significant reduction of death or major disability but improves functional outcomes.
IVH, general management, the FALSE answer is:
-
A.
ICU admission, elevating the head of bed, analgesia, mild sedation, MANNITOL.
-
B.
Antiepileptic drug (AED) prophylaxis is controversial.
-
C.
BP control target SBP < 110 mmHg.
-
D.
Small hematomas and limited IVH usually do not need ICP treatment.
-
E.
Early intensive lowering of BP does not result in a significant reduction of death or major disability but improves functional outcomes.
Answer C
-
Target SBP < 140 mmHg, keep MAP 70–110 mmHg.
-
7.
IVH, surgical treatment, the FALSE answer is:
-
A.
Ventricular drainage as a treatment for hydrocephalus is reasonable, especially if decreased level of consciousness.
-
B.
Endoscopic neurosurgical techniques for IVH evacuation may be advantageous compared with EVD.
-
C.
CLEAR (Clot Lysis Evaluating Accelerated Resolution of IVH) III trial suggests that rtpa may be effective in reducing the volume of IVH.
-
D.
Ventricular drainage is recommended in IVH associated with cerebellar hematoma.
-
E.
Chronic hydrocephalus following IVH can be treated by VP shunt.
IVH, surgical treatment, the FALSE answer is:
-
A.
Ventricular drainage as a treatment for hydrocephalus is reasonable, especially if decreased level of consciousness.
-
B.
Endoscopic neurosurgical techniques for IVH evacuation may be advantageous compared with EVD.
-
C.
CLEAR (Clot Lysis Evaluating Accelerated Resolution of IVH) III trial suggests that rtpa may be effective in reducing the volume of IVH.
-
D.
Ventricular drainage is recommended in IVH associated with cerebellar hematoma.
-
E.
Chronic hydrocephalus following IVH can be treated by VP shunt.
Answer D
-
EVD has a risk of upward herniation of cerebellum hemorrhage with IVH and does not relieve brainstem compression. Initial treatment with ventricular drainage rather the surgical evacuation is not recommended.
-
8.
IVH, prognosis, the FALSE answer is:
-
A.
Patient age is considered as an important prognostic factor.
-
B.
Patients with lower Graeb scores were associated with better clinical conditions.
-
C.
A smaller volume of IVH is favorable.
-
D.
The development of hydrocephalus carries a poor prognosis.
-
E.
Secondary IVH showed a better prognosis than primary.
IVH, prognosis, the FALSE answer is:
-
A.
Patient age is considered as an important prognostic factor.
-
B.
Patients with lower Graeb scores were associated with better clinical conditions.
-
C.
A smaller volume of IVH is favorable.
-
D.
The development of hydrocephalus carries a poor prognosis.
-
E.
Secondary IVH showed a better prognosis than primary.
Answer E
-
The outcome of patients with primary IVH is better than those with secondary IVH.
-
9.
Intraventricular hemorrhage in newborn (IVH-n), alternate terms, the FALSE answer is:
-
A.
Subependymal hemorrhage.
-
B.
Germinal matrix hemorrhage.
-
C.
Periventricular- IVH.
-
D.
Choroid plexus hemorrhage.
-
E.
Neonatal IVH.
Intraventricular hemorrhage in newborn (IVH-n), alternate terms, the FALSE answer is:
-
A.
Subependymal hemorrhage.
-
B.
Germinal matrix hemorrhage.
-
C.
Periventricular- IVH.
-
D.
Choroid plexus hemorrhage.
-
E.
Neonatal IVH.
Answer D
-
Choroid plexus hemorrhage can result in IVH, but not a term of IVH-n.
-
10.
IVH-n, pathogenesis, the FALSE answer is:
-
A.
Birth asphyxia.
-
B.
Hypercapnia.
-
C.
Increased systematic venous pressure.
-
D.
Hypertension.
-
E.
Rapid i.v. resuscitation.
IVH-n, pathogenesis, the FALSE answer is:
-
A.
Birth asphyxia.
-
B.
Hypercapnia.
-
C.
Increased systematic venous pressure.
-
D.
Hypertension.
-
E.
Rapid i.v. resuscitation.
Answer D
-
Hypotension and hypoperfusion.
-
11.
IVH-n, anatomy of the germinal matrix, the FALSE answer is:
-
A.
Located in the thick subependymal cell layer of the thalamostriate groove.
-
B.
Vulnerable watershed zone.
-
C.
Origin to both neural and glial cells.
-
D.
Progressive involution until 36 weeks.
-
E.
Supplied by terminal branches of posterior cerebral arteries.
IVH-n, anatomy of the germinal matrix, the FALSE answer is:
-
A.
Located in the thick subependymal cell layer of the thalamostriate groove.
-
B.
Vulnerable watershed zone.
-
C.
Origin to both neural and glial cells.
-
D.
Progressive involution until 36 weeks.
-
E.
Supplied by terminal branches of posterior cerebral arteries.
Answer E
-
Supplied by Heubner’s artery, terminal branches of the lateral striate arteries, and the anterior choroidal artery.
-
12.
IVH-n, risk factors, the FALSE answer is:
-
A.
Young gestational age.
-
B.
Increase CPP.
-
C.
Coagulopathy.
-
D.
Maternal cocaine use.
-
E.
Macrosomia.
IVH-n, risk factors, the FALSE answer is:
-
A.
Young gestational age.
-
B.
Increase CPP.
-
C.
Coagulopathy.
-
D.
Maternal cocaine use.
-
E.
Macrosomia.
Answer E
-
Low birth weight considers an important risk factor.
-
13.
IVH-n, incidence, the FALSE answer is:
-
A.
More in male.
-
B.
Low birth weight in 25%.
-
C.
Mortality rate 10%.
-
D.
Bimodal distribution.
-
E.
Mortality correlated to gestational age.
IVH-n, incidence, the FALSE answer is:
-
A.
More in male.
-
B.
Low birth weight in 25%.
-
C.
Mortality rate 10%.
-
D.
Bimodal distribution.
-
E.
Mortality correlated to gestational age.
Answer C
-
Mortality can reach 55%.
-
14.
IVH-n, prevention, the FALSE answer is:
-
A.
Regular prenatal care.
-
B.
Avoid preterm labor.
-
C.
Avoid corticosteroid.
-
D.
Indomethacin.
-
E.
Surfactant.
IVH-n, prevention, the FALSE answer is:
-
A.
Regular prenatal care.
-
B.
Avoid preterm labor.
-
C.
Avoid corticosteroid.
-
D.
Indomethacin.
-
E.
Surfactant.
Answer C
-
Antenatal corticosteroid administration used for prevention.
-
15.
IVH-n, papile grading, the FALSE answer is:
-
A.
Grade I: Hemorrhage restricted to subependymal region.
-
B.
Grade II: IVH without ventricular dilatation.
-
C.
Grade III: IVH with ventricular dilatation.
-
D.
Grade IV: IVH with parenchymal hemorrhage.
-
E.
Grade V: IVH with SAH.
IVH-n, papile grading, the FALSE answer is:
-
A.
Grade I: Hemorrhage restricted to subependymal region.
-
B.
Grade II: IVH without ventricular dilatation.
-
C.
Grade III: IVH with ventricular dilatation.
-
D.
Grade IV: IVH with parenchymal hemorrhage.
-
E.
Grade V: IVH with SAH.
Answer E
-
The grading system for primary IVH is four grades only.
-
16.
IVH-n, papile grading, the FALSE answer is:
-
A.
Grade I: seen in the 7 caudothalamic groove.
-
B.
Grade II: poor prognosis.
-
C.
Grade III: 20% mortality.
-
D.
Grade IV: 36% mortality.
-
E.
Grade IV: secondary to hemorrhagic infarction.
IVH-n, papile grading, the FALSE answer is:
-
A.
Grade I: seen in the 7 caudothalamic groove.
-
B.
Grade II: poor prognosis.
-
C.
Grade III: 20% mortality.
-
D.
Grade IV: 36% mortality.
-
E.
Grade IV: secondary to hemorrhagic infarction.
Answer B
-
Grade II overall good prognosis.
-
17.
IVH-n, presentation, the FALSE answer is:
-
A.
Flaccid paralysis.
-
B.
Subclinical seizures.
-
C.
Depressed fontanelle.
-
D.
Hypotension.
-
E.
Unreactive pupils.
IVH-n, presentation, the FALSE answer is:
-
A.
Flaccid paralysis.
-
B.
Subclinical seizures.
-
C.
Depressed fontanelle.
-
D.
Hypotension.
-
E.
Unreactive pupils.
Answer C
-
Tense fontanelle.
-
18.
IVH-n, hydrocephalus, the FALSE answer is:
-
A.
50% of infants.
-
B.
More in Grade I.
-
C.
Young gestational age infants may be at higher risk.
-
D.
Occurs 1 week after hemorrhage.
-
E.
Most cases are due to cellular debris.
IVH-n, hydrocephalus, the FALSE answer is:
-
A.
50% of infants.
-
B.
More in Grade I.
-
C.
Young gestational age infants may be at higher risk.
-
D.
Occurs 1 week after hemorrhage.
-
E.
Most cases are due to cellular debris.
Answer B
-
Grades III and IV are more often associated with progressive ventricular dilatation than are lower grades.
-
19.
IVH-n, general measures, the FALSE answer is:
-
A.
Maintaining normal MAP.
-
B.
Normalizing pCO2.
-
C.
Treating active hydrocephalus.
-
D.
Daily LPs if needed.
-
E.
Diuretic therapy.
IVH-n, general measures, the FALSE answer is:
-
A.
Maintaining normal MAP.
-
B.
Normalizing pCO2.
-
C.
Treating active hydrocephalus.
-
D.
Daily LPs if needed.
-
E.
Diuretic therapy.
Answer E
-
Furosemide and acetazolamide therapy are not safe and not effective in treating post-hemorrhagic ventricular dilatation.
-
20.
IVH-n, intervention includes, the FALSE answer is:
-
A.
Lumbar drain.
-
B.
Lumbar puncture.
-
C.
Ventricular tap.
-
D.
Temporary ventricular access device.
-
E.
VP shunt.
IVH-n, intervention includes, the FALSE answer is:
-
A.
Lumbar drain.
-
B.
Lumbar puncture.
-
C.
Ventricular tap.
-
D.
Temporary ventricular access device.
-
E.
VP shunt.
Answer A
-
21.
Intracranial aneurysms, associated IVH, the FALSE answer is:
-
A.
The frontal horn hemorrhage and rupture of PcommA aneurysm.
-
B.
Third ventricle and rupture of AcommA aneurysm.
-
C.
Third ventricle and rupture of carotid terminus aneurysm.
-
D.
Fourth ventricle and rupture of PICA aneurysm.
-
E.
Lateral ventricle and rupture of AcommA aneurysm.
Intracranial aneurysms, associated IVH, the FALSE answer is:
-
A.
The frontal horn hemorrhage and rupture of PcommA aneurysm.
-
B.
Third ventricle and rupture of AcommA aneurysm.
-
C.
Third ventricle and rupture of carotid terminus aneurysm.
-
D.
Fourth ventricle and rupture of PICA aneurysm.
-
E.
Lateral ventricle and rupture of AcommA aneurysm.
Answer A
-
Ruptured PcommA aneurysm will cause carotid cistern, optic cistern, and sylvian cistern SAH; also, it can cause a subdural hematoma.
-
22.
Intraventricular vascular lesions includes the following, the FALSE answer is:
-
A.
AVM.
-
B.
Cavernoma.
-
C.
Carotid-cavernous fistula.
-
D.
Telangiectasia.
-
E.
Venous angiomas.
Intraventricular vascular lesions includes the following, the FALSE answer is:
-
A.
AVM.
-
B.
Cavernoma.
-
C.
Carotid-cavernous fistula.
-
D.
Telangiectasia.
-
E.
Venous angiomas.
Answer C
-
23.
Intraventricular vascular lesions, characteristics, the FALSE answer is:
-
A.
No sex predominance.
-
B.
Common in adults.
-
C.
Third ventricle most common site.
-
D.
Mimic tumor on radiology.
-
E.
Associated with congenital anomalies.
Intraventricular vascular lesions, characteristics, the FALSE answer is:
-
A.
No sex predominance.
-
B.
Common in adults.
-
C.
Third ventricle most common site.
-
D.
Mimic tumor on radiology.
-
E.
Associated with congenital anomalies.
The answer is C.
-
The lateral ventricle is the most frequent origin, followed by the third ventricle.
-
24.
Intraventricular aneurysms, characteristics, the FALSE answer is:
-
A.
Presented with isolated IVH.
-
B.
Giant aneurysms.
-
C.
The first option for management is endovascular.
-
D.
Very rare.
-
E.
Good prognosis.
Intraventricular aneurysms, characteristics, the FALSE answer is:
-
A.
Presented with isolated IVH.
-
B.
Giant aneurysms.
-
C.
The first option for management is endovascular.
-
D.
Very rare.
-
E.
Good prognosis.
Answer B
-
Intraventricular aneurysms are frequently very small (<5 mm diameter).
-
25.
Intraventricular Cerebral Cavernomas (IVCs), characteristics, the FALSE answer is
-
A.
Occur in Only 2–10% of Patients with Cerebral Cavernomas
-
B.
It Is Genetically Inherited Disorder
-
C.
Good prognosis.
-
D.
Equally in Males and Females
-
E.
Almost all Patients Presented with an Acute Headache on Admission
Intraventricular Cerebral Cavernomas (IVCs), characteristics, the FALSE answer is
-
A.
Occur in Only 2–10% of Patients with Cerebral Cavernomas
-
B.
It Is Genetically Inherited Disorder
-
C.
Good prognosis.
-
D.
Equally in Males and Females
-
E.
Almost all Patients Presented with an Acute Headache on Admission
Answer B
-
Reports concerning IVC are scarce and are limited mostly to sporadic case reports.
-
26.
(IVCs), characteristics, the FALSE answer is
-
A.
The Mean Age of the Patients Is 36.5 Years
-
B.
Can Be Presented by IVH
-
C.
The most Frequent Location Is the Fourth Ventricle
-
D.
Complete Surgical Resection Is the Treatment of Choice
-
E.
The Microsurgical Approach Is Currently Considered the Gold Standard for IVC Resection
(IVCs), characteristics, the FALSE answer is
-
A.
The Mean Age of the Patients Is 36.5 Years
-
B.
Can Be Presented by IVH
-
C.
The most Frequent Location Is the Fourth Ventricle
-
D.
Complete Surgical Resection Is the Treatment of Choice
-
E.
The Microsurgical Approach Is Currently Considered the Gold Standard for IVC Resection
Answer C
-
The most frequent location is the lateral ventricle about 52.6%.
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Elamin, O., Muthana, A., Hasan, H.M., Matti, W.E., Kadhum, H.J., Hoz, S.S. (2023). Cerebral Ventricle: Vascular Lesions and Hemorrhage. In: Salih, H.R., et al. Cerebral Ventricles . Springer, Cham. https://doi.org/10.1007/978-3-031-42342-0_18
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