Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase

Abstract

Six patients with severe intraventricular hemorrhage were treated with direct intraventricular infusion of urokinase. In each case, hemorrhage extended into all ventricular chambers, and a cast formation and expansion of the third and fourth ventricles were found. Immediately after the therapy was started (within 7 days from onset of symptoms), reduction of intraventricular hematoma volume was observed on computerized tomography. On average, both the third and fourth ventricles became clear on the third day after hemorrhage; there was one exception, a case of ruptured aneurysm. Five of the six patients showed excellent or good outcome, although two developed delayed hydrocephalus. No infection or rebleeding was observed. The outcome in a retrospectively studied group of five patients not treated with urokinase is also reported. The authors conclude that this relatively easy method of treatment will greatly improve the prognosis of severe intraventricular hemorrhage.

A Cohort Study of the Safety and Feasibility of Intraventricular Urokinase for Nonaneurysmal Spontaneous Intraventricular Hemorrhage

“…This feature of the protocol for UK administration was based on previous findings. 9 In our cohort, clearance of the third ventricle occurred sooner in patients who received UK, and clearance of the third ventricle portended better outcome. This suggests that relief of third ventricular obstruction may be the key observation to guide successful treatment of UK therapy of IVH, and perhaps clearance of third ventricular hemorrhage should be the end point of treatment.…”

“…Other series 9,12,[15][16][17][18] have reported a combined total of 59 patients given intraventricular thrombolytics for spontaneous IVH from either aneurysmal or presumed parenchymal rupture; of these, 17 received UK. 9,12,15 None of these series looked at the same outcome measures we used (eg, LOS), nor did any have a sizable contemporaneous cohort managed without adjunctive thrombolytics.…”

“…Reported mortality from IVH is in the neighborhood of 80%, regardless of surgical interventions such as ventriculostomy or stereotactic or transcortical hematoma evacuation. [3][4][5][6][7][8][9] CT studies 6 reveal that spontaneous IVH resolution usually occurs within 3 weeks. Others have reported some improvement of outcome by speeding intraventricular thrombolysis (with hematoma resolution occurring often within a few days) with use of either UK 9 -15 or r-tPA.…”

Effect of treatment modality on in-hospital outcome in patients with subarachnoid hemorrhage: a nationwide study in Japan (J-ASPECT Study)

“…The JCS is widely used for the assessment of impaired consciousness in patients with SAH in Japan. 2,12,14,25,32 Although the JCS cannot assess neurological impairment other than diminished consciousness, the JCS score on admission had the greatest impact on the outcomes of patients with SAH. 9 In addition, JCS scores have been reported to correlate with stroke outcomes.…”

External ventricular drainage alone versus endoscopic surgery for severe intraventricular hemorrhage: a comparative retrospective analysis on outcome and shunt dependency

“…What is not clear from the literature, however, is whether such treatment results in an improved neurological outcome of the survivors. Shen et al, 43 Akdemir et al, 1 and Todo et al 46 reported good recovery with or without moderate disability in 50%-83% of the patients who received this treatment. However, 1 cohort study found that a larger proportion of the survivors remained in a vegetative state (31.8% treatment group vs 11.1% control group).…”