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<p>Spontaneous intracerebral hemorrhage (ICH) is commonly associated with intraventricular hemorrhage (IVH), which is considered an independent predictor of mortality and poor functional outcomes. However, little is known about the prognostic value of blood volume in various regions of the ventricular system. We aimed to characterize the extent of IVH in different regions of the ventricular system in patients with ICH and to assess its association with the risk of mortality. We conducted a retrospective cohort analysis of patients with ICH admitted to our institution between 2010 and 2022. We gathered epidemiological, clinical, and radiological data. The primary outcome of interest was in-hospital mortality. We included 1,048 patients. Four hundred forty-three patients (42.4%) presented IVH associated with ICH, and the overall mortality rate was 32.4%. In the univariate analysis, mortality increased with age, female sex, worse neurological condition at admission, anticoagulation, ICH location, and ICH volume. The presence of IVH was associated with higher mortality, as was IVH extension in the lateral, third, and fourth ventricles. The multivariate model showed that age, initial Glasgow Coma Scale (GCS), anticoagulation, surgical management, brainstem hemorrhage, ICH volume, and IVH in the lateral ventricles were significant factors. Notably, IVH involvement of one lateral ventricle doubled the risk of death (OR 2.05), while bilateral involvement almost quadrupled it (OR 3.93). Conversely, intraventricular extension limited to the ventricular horns did not elevate the risk of mortality. We next modified the original ICH score by incorporating only lateral ventricular involvement, weighted according to the prognostic gradient identified in the multivariable analysis. Comparison of our proposed ICH score to the original ICH score showed non-inferiority. Thus, accounting for the extent of lateral ventricular IVH improves risk stratification for short-term mortality. Collectively, our results underscore the clinical relevance of IVH topography beyond a binary assessment of intraventricular extension.</p>

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Topographic patterns of intraventricular hemorrhage extension and their prognostic significance in intracerebral hemorrhage

  • 期刊论文

  • 发表日期：

    2026年2月26日

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  • Daniel García-Pérez,
  • Juan Campos,
  • Óscar Ayo-Martín,
  • Tomás Segura,
  • Gemma Serrano-Heras

摘要

Spontaneous intracerebral hemorrhage (ICH) is commonly associated with intraventricular hemorrhage (IVH), which is considered an independent predictor of mortality and poor functional outcomes. However, little is known about the prognostic value of blood volume in various regions of the ventricular system. We aimed to characterize the extent of IVH in different regions of the ventricular system in patients with ICH and to assess its association with the risk of mortality. We conducted a retrospective cohort analysis of patients with ICH admitted to our institution between 2010 and 2022. We gathered epidemiological, clinical, and radiological data. The primary outcome of interest was in-hospital mortality. We included 1,048 patients. Four hundred forty-three patients (42.4%) presented IVH associated with ICH, and the overall mortality rate was 32.4%. In the univariate analysis, mortality increased with age, female sex, worse neurological condition at admission, anticoagulation, ICH location, and ICH volume. The presence of IVH was associated with higher mortality, as was IVH extension in the lateral, third, and fourth ventricles. The multivariate model showed that age, initial Glasgow Coma Scale (GCS), anticoagulation, surgical management, brainstem hemorrhage, ICH volume, and IVH in the lateral ventricles were significant factors. Notably, IVH involvement of one lateral ventricle doubled the risk of death (OR 2.05), while bilateral involvement almost quadrupled it (OR 3.93). Conversely, intraventricular extension limited to the ventricular horns did not elevate the risk of mortality. We next modified the original ICH score by incorporating only lateral ventricular involvement, weighted according to the prognostic gradient identified in the multivariable analysis. Comparison of our proposed ICH score to the original ICH score showed non-inferiority. Thus, accounting for the extent of lateral ventricular IVH improves risk stratification for short-term mortality. Collectively, our results underscore the clinical relevance of IVH topography beyond a binary assessment of intraventricular extension.