What is an intraventricular hemorrhage?

Causes and Symptoms

Intraventricular hemorrhage (IVH) occurs most commonly in premature babies, especially those weighing under 1,500 grams (3 pounds, 5 ounces.). IVHs have been seen as well in adults as a secondary complication of hemorrhagic stroke, leaving the individual with a poor prognosis.

IVH in premature babies is thought to occur when there is oxygen deprivation during delivery or complications following delivery. Since the blood vessels in the brain of the baby are fragile, they may rupture easily, resulting in excessive bleeding into (intraventricular) or around (periventricular) the ventricles. Generally, there are no outward symptoms. Some infants with IVH may suddenly develop seizures or anemia. IVH is usually diagnosed by cranial ultrasound routinely done on high-risk infants between three and ten days of life, since most cases occur by day three.

Intraventricular hemorrhages are categorized into four grades based on severity. Grade I involves bleeding confined to the small area where it began. Grade II involves blood extending into the ventricles, with no ventricular enlargement. Grade III involves more blood extending into the ventricles, with ventricular enlargement. Grade IV has blood collecting within the brain tissue (intraparenchymal hemorrhage), reflecting injury to the brain. Hydrocephalus (or too much fluid in the brain wherein the spaces, or ventricles, become enlarged) is a common complication of Grade III or IV bleeds.

Treatment and Therapy

Premature babies are given intravenous indomethacin once daily for the first three days of life in order to decrease the likelihood of severe IVH. Steroids (corticosteroids) given to the mother prior to delivery have also decreased the frequency of severe IVH, as have improved monitoring and care of premature babies. No specific treatment exists for IVH, except to treat symptoms and underlying health problems. If hydrocephalus develops, it can be treated with frequent lumbar punctures or ventricular taps. If the condition persists, a shunt may be placed surgically to drain the extra CSF throughout life. In adults who suffer IVH secondary to hemorrhagic stroke, fibrolytic agents (so-called clot busters) are being evaluated as a mode of treatment.

Perspective and Prospects

IVH has been reported in 35 to 50 percent of infants weighing under 1,500 grams (3 pounds, 5 ounces). If IVH is suspected, a doctor may order an ultrasound to diagnose the condition and evaluate the amount of bleeding. As gestational age increases, the likelihood of IVH decreases. The care of sick and premature babies has advanced greatly, but there is still no way to definitively prevent IVH from occurring. Grade I IVHs rarely involve long-term problems. Those classified as Grade IV generally do result in long-term sequelae, including motor problems, developmental delay, seizures, blindness, and deafness.

Bibliography

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Kim, Beom, et al. "Extents of White Matter Lesions and Increased Intraventricular Extension of Intracerebral Hemorrhage." Critical Care Medicine 41.5 (2013): 1325–331. Print.

Klaus, Marshall H., and Avroy A. Fanaroff, eds. Care of the High-Risk Neonate. 5th ed. Philadelphia: Saunders, 2001. Print.

Maas, Matthew B., et al. "Delayed Intraventricular Hemorrhage is Common and Worsens Outcomes in Intracerebral Hemorrhage." Neurology 80.14 (2013): 1295–299. Print.

Victor, Maurice, and Allan H. Ropper. Adams and Victor’s Principles of Neurology. 9th ed. New York: McGraw, 2009. Print.

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