Prognostic Factors In The Fourth Intraventricular Hemorrhage:a Clinical Retrospective Study

Previous studies indicated that intraventricular hemorrhage (IVH)is an important outcome predictor in patients with intraparenchymal hemorrhage and subarachnoid hemorrhage (SAH). Volume of IVH,the presence of enlarged ventricles and hemorrhagic dilation of the fourth ventricle are sensitive factors in predicting survival in IVH. An analysis of 70 patients with CT-documented fourth IVH,treated between 1995 and 2000 is presented. Our object is to determine the outcome predictors in the fourth IVH. Overall,39 patients (56%)had hemorrhagic dilation of the fourth ventricle and 36 patients died in spite of aggressive therapy. 31 patients (44%)had fourth IVH without dilation;of these,1 l(35%)died and 20 (65%)experienced functional survival. The survival rate was significantly worse for patients with dilation of the fourth ventricle(P<0.() 1 ,chi-squared test ).Of the 39 patients with fourth IVH associated with dilation,31 presented with a Glasgow Coma Scale (GCS) score of 3 to 5,3 with a GCS score of 6 to 8,and 13 with a GCS score of 9 to 15. For the 31 patients with fourth IVH and no dilation,14 with a GCS sore of 3 to 5 (10 died),4 with a GCS score of 6 to 8 (none died) and 15 with a GCS score of 9 to 1 5 (one died). There was a greater chance of higher GCS scores in patients with fourth IVH and no dilation (PO.01 ). of the 39 patients with fourth IVH associated with dilation,20 had no reaction of bilateral pupils. 5 had reaction of unilateral pupil and 14 had reaction of bilateral pupils. For the 31 patients with fourth IVH and no dilation,6 had no reaction of bilateral pupils (5 died),1 had reaction of unilateral pupil (none died)and24 had reaction of bilateral pupils. There was a better pupil reaction in patients with fourth IVH and no dilation(P<0.01). Of the 39 patients with fourth IVH associated with dilation,34 had diffuse clot,involving the lateral and third ventricles as well,and 5 had isolated fourth IVH. Of the 31 patients with fourth IVH and no dilation,16 had diffuse clot (10 died) and 15 had isolated clot (1 died). Diffuse ventricular clot was associated with an increased mortality rate for patients with fourth IVH and no dilation (P<0.0 1).Logistic regression multivariate analysis showed hemorrhagic dilation of the fourth ventricle to be the most significant outcome predictor (P < 0.001),followed by GCS (P=0.017),pupil reaction (p=0.017) and the presence of diffuse IVH (p=0.036).Conclusion:The hemorrhagic dilation of the fourth ventricle is the strongest outcome predictor in the fourth IVH.