Worldwide, intraventricular hemorrhage (IVH) accounts for only 3% of intracranial bleeding. IVH typically occurs as a secondary phenomenon when an intracerebral or subarachnoid hemorrhage extends into the ventricles. Thus, hypertension is also found in nearly half of individuals with IVH. Primary IVH is uncommon and is usually due to vascular malformations. Patients with IVH typically present with abrupt onset headache, nausea, vomiting, and varying degrees of impaired consciousness. Focal neurologic findings are uncommon. The diagnostic test of choice for IVH is a noncontrast head CT. After the CT, MRI or MRA can be used to identify the anatomical cause of the hemorrhage. Treatment is aimed at cessation of the bleeding, reducing hydrocephalus, and managing raised intracranial pressure. Gradual lowering of blood pressure, placement of an intraventricular drain, and treating the specific cause (eg, repair of the aneurysm or obliteration of the AVM) should be undertaken.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.