Intraventricular hemorrhage etiology

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1. Most occur as a result of the extension of intraparenchymal hemorrhages

a) in the adult:

● spontaneous intracerebral hemorrhage: especially thalamic hemorrhage or putaminal hemorrhage.

● associated with arteriovenous malformation.

b) in newborns: extension of subependymal hemorrhage (Periventricular-intraventricular hemorrhage)

2. pure intraventricular hemorrhage (IVH) is usually the result of a rupture of

a) aneurysm: accounts for ≈ 25% of IVH in adults, and is second only to extension of intracerebral hemorrhage as the most common cause. IVH occurs in 13–28% of ruptured aneurysms in clinical series ¹⁾. More common with the following aneurysms: a-comm, distal basilar artery or carotid terminus, VA or distal PICA (for patterns)

b) vertebral artery dissection (or dissecting aneurysms)

c) intraventricular arteriovenous malformation

d) intraventricular tumor

e) SAH outside the ventricles refluxing into foramina of Luschka and/or Magendie

Chyloma-induced intraventricular hemorrhage ²⁾

While intraventricular hemorrhage is frequently found in association with intraparenchymal or subarachnoid hemorrhage, isolated intraventricular hemorrhage (iIVH) is rare in adults and seldom described. Awareness of possible causes is important in order to guide patient management. After elimination of a traumatic cause, numerous aetiologies remain possible. The most frequently found underlying lesions are arteriovenous malformations and aneurysms, but other vascular causes should also be sought, including cavernous malformations and moyamoya disease. Arterial hypertension, anticoagulant use, coagulopathies and certain toxic substances are also associated with iIVH. Finally, iIVH may be caused by intraventricular tumours. In a high number of cases, the cause remains unknown. Vascular and non-vascular causes should be searched through an imaging work-up (with CT angiography, MRI and catheter angiography when necessary) and correlation with clinical information to yield a diagnosis ³⁾.

Intraventricular arteriovenous malformation