[Primary ventricular hemorrhage].

BACKGROUND

Primary intraventricular hemorrhage is non-traumatic cerebral hemorrhage limited to the ventricular system which presents on rare occasions, forming 3% of the spontaneous cerebral hemorrhages.

METHODS

The diagnosis may be suspected when there is sudden onset of headache, nausea and vomiting with reduced level of consciousness. On examination there are signs of meningism, bilateral positive Babinski signs and absence of localizing neurological signs. However, cases of more subacute onset or with a normal state of consciousness are also seen. Therefore, in spite of clinical suspicion, diagnosis is made on cerebral computerized tomography. The aetiology is varied and it should be emphasized that vascular malformations cause 34% and in 21-47% no cause is found. Probably arterial hypertension is a major cause of primary intraventricular haemorrhage (38.5% in one series). Arteriography is necessary as well as computerized tomography for diagnosis of the aetiology. The prognosis is relatively good. The mortality is 29% and most survivors become asymptomatic or are left with only minor sequelae, often characterized by memory problems. In elderly patients there is a worse prognosis if there is an initial alteration in consciousness and if hydrocephaly occurs, but the prognosis does not appear to be affected by the volume of the hemorrhage. There is no specific treatment, but promising results have been obtained with intrathecal administration of fibrinolytic agents followed by external drainage.