Massive recurrent intraventricular hemorrhage without vascular abnormality treated

Massive recurrent intraventricular hemorrhage without vascular abnormality treated with alteplase. A case report C. ANAGNOSTOPOULOS 1, GF. HADJIGEORGIOU 2, A. PETSANAS 1, P. TSELIOTI 3, V. GRAMMATIKOPOULOU 3, A. PREKATES 3, N. SAKELLARIDIS 1 1 DEPARTMENT OF NEUROSURGERY, TZANIO GENERAL HOSPITAL, GREECE 2 DEPARTMENT OF NEUROSURGERY, RED CROSS HOSPITAL, ATHENS, GREECE 3 INTENSIVE CARE UNIT, TZANIO GENERAL HOSPITAL, PIREAUS, GREECE KEYWORDS: INTRAVENTRICULAR, HEMORRHAGE, ALTEPLASE

Massive recurrent intraventricular hemorrhage without vascular abnormality treated with alteplase. A case report C. Anagnostopoulos 1, GF. Hadjigeorgiou 2, A. Petsanas 1, P. Tselioti 3, V. Grammatikopoulou 3, A. Prekates 3, N. Sakellaridis 1 Introduction v. Intraventricular hemorrhage (IVH) is a clinical entity that is associated with high mortality and morbidity. Treating massive IVH only with external ventricular drainage (EVD) does not always improve the outcome of the patients.

Massive recurrent intraventricular hemorrhage without vascular abnormality treated with alteplase. A case report C. Anagnostopoulos 1, GF. Hadjigeorgiou 2, A. Petsanas 1, P. Tselioti 3, V. Grammatikopoulou 3, A. Prekates 3, N. Sakellaridis 1 Aim v. To present the management of a patient with massive recurrent IVH without an underlying vascular abnormality with the combination of EVD and intraventricular administration of alteplase

Massive recurrent intraventricular hemorrhage without vascular abnormality treated with alteplase. A case report C. Anagnostopoulos 1, GF. Hadjigeorgiou 2, A. Petsanas 1, P. Tselioti 3, V. Grammatikopoulou 3, A. Prekates 3, N. Sakellaridis 1 Material-Methods v We report a case of a 56 -year-old male, with a history of hypertension under treatment, who was transferred to the hospital comatose on a GCS of 7 (E 1 V 1 M 5) after a hypertensive crisis. The computed tomography of the brain revealed massive IVH and obstructive hydrocephalus. He underwent bilateral EVD placement. The digital subtraction angiography (DSA) of the brain was negative.

Massive recurrent intraventricular hemorrhage without vascular abnormality treated with alteplase. A case report C. Anagnostopoulos 1, GF. Hadjigeorgiou 2, A. Petsanas 1, P. Tselioti 3, V. Grammatikopoulou 3, A. Prekates 3, N. Sakellaridis 1 Material-Methods v Even though he had gradual resolution of the clot, ten days after the first bleed he suffered a second episode of the same extent. We decided to start intraventricular administration of alteplase (recombinant tissue plasminogen activator). The patient received treatment with alteplase – 1 mg twice daily for seven days. Complete resolution of the hemorrhage was observed ten days after initiating the administration. A ventriculoperitoneal shunt was inserted two months after the first hemorrhage. Image 1: CT scan on admission Image 2: CT scan on the 10 th day showing gradual resolution of the clot Image 3: CT scan after the rebleeding Image 4: CT scan 3 days after the initiation of treatment with alteplase Image 5: CT scan 9 days after the initiation of alteplase

Massive recurrent intraventricular hemorrhage without vascular abnormality treated with alteplase. A case report C. Anagnostopoulos 1, GF. Hadjigeorgiou 2, A. Petsanas 1, P. Tselioti 3, V. Grammatikopoulou 3, A. Prekates 3, N. Sakellaridis 1 Results v The patient three months after the first hemorrhage was transferred to the rehabilitation unit in a very good condition (Glasgow Outcome Scale: 4)

Massive recurrent intraventricular hemorrhage without vascular abnormality treated with alteplase. A case report C. Anagnostopoulos 1, GF. Hadjigeorgiou 2, A. Petsanas 1, P. Tselioti 3, V. Grammatikopoulou 3, A. Prekates 3, N. Sakellaridis 1 Conclusion v. We suggest that in selected cases of massive intraventricular hemorrhage with no underlying vascular abnormality, the placement of bilateral EVD and the intraventricular administration of alteplase results in early lysis of the blood clot and improves the outcome of the patients.