====== Intraventricular hemorrhage treatment ======

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Various medical and surgical modalities have been employed for the management of this entity with variable success and complications rates. Abunimer et al., review the neurosurgical interventions for the management of intraventricular hemorrhage and describe new approaches and potential therapeutic modalities for the management of this devastating condition
((Abunimer AM, Abou-Al-Shaar H, Cavallo C, Mahan MA, Labib MA. Minimally
invasive approaches for the management of intraventricular hemorrhage. J
Neurosurg Sci. 2018 May 28. doi: 10.23736/S0390-5616.18.04511-3. [Epub ahead of
print] PubMed PMID: 29808639.
)).

[[Intraventricular hemorrhage management]].

===== Blood pressure management =====

The 2007 [[American Heart Association]]/[[American Stroke Association]] [[guideline]]s recommend treating [[systolic blood pressure]] (SBP) greater than 180 mm Hg or [[diastolic blood pressure]] greater than 105 mm Hg
((Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation. 2007;116(16):e391–e413. These guidelines for managing ICH form the standard of care for both ICH and IVH)).

Target SBP goals ≥ 160 mm Hg are associated with hematoma enlargement compared with SBP goals ≤ 150 mm Hg
((Ohwaki K, Yano E, Nagashima H, et al. Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke. 2004;35(6):1364–1367.)).

Of note, poorly controlled [[diabetes]] and [[SBP]] greater than 200 mm Hg at admission portend a high risk of [[hematoma expansion]]
((Kazui S, Naritomi H, Yamamoto H, et al. Enlargement of spontaneous intracerebral hemorrhage. Incidence and time course. Stroke. 1996;27(10):1783–1787.)).


Early intensive BP-lowering treatment had no clear effect on IVH in acute ICH
((Chan E, Anderson CS, Wang X, Arima H, Saxena A, Moullaali TJ, Delcourt C, Wu
G, Wang J, Chen G, Lavados PM, Stapf C, Robinson T, Chalmers J; INTERACT
Investigators. Early Blood Pressure Lowering Does Not Reduce Growth of
Intraventricular Hemorrhage following Acute Intracerebral Hemorrhage: Results of 
the INTERACT Studies. Cerebrovasc Dis Extra. 2016 Sep 8;6(3):71-75. [Epub ahead
of print] PubMed PMID: 27603933.
)).

===== Intraventricular tissue plasminogen activator =====

see [[Intraventricular tissue plasminogen activator]].