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Clin Neurol Neurosurg. 2018 Jan;164:92-96. doi: 10.1016/j.clineuro.2017.11.019. Epub 2017 Dec 22.

Intraventricular hemorrhage related to AVM rupture: Description, outcomes and impact of intraventricular fibrinolysis.

Author information

1
Department of Neurosurgery, Rouen University Hospital, Rue de Germont, Rouen, France. Electronic address: vianneygilard@hotmail.fr.
2
Inserm, UMR-S U919, Serine Proteases and Pathophysiology of the Neurovascular Unit, GIP Cyceron, University Caen Lower-Normandy, Bd Henri Becquerel, Caen, France.
3
Department of Neurosurgery, Caen University Hospital, Avenue de la côte de Nacre, Caen, France; Department of Anesthesiology and Neurocritical Care, Caen University Hospital, Avenue de la côte de Nacre, Caen, France.
4
Department of Neurosurgery, Rouen University Hospital, Rue de Germont, Rouen, France.
5
Department of Neurosurgery, Strasbourg University Hospital, 1 Avenue Moliere, Strasbourg, France.
6
Department of Neurosurgery, Caen University Hospital, Avenue de la côte de Nacre, Caen, France; Inserm, UMR-S U919, Serine Proteases and Pathophysiology of the Neurovascular Unit, GIP Cyceron, University Caen Lower-Normandy, Bd Henri Becquerel, Caen, France; Université Caen Normandie, Medical School, Caen, F-14000, France.

Abstract

OBJECTIVES:

Arteriovenous malformation (AVM) rupture could lead to intraventricular hemorrhage (IVH), a particularly severe form of intracranial bleeding. The epidemiology, presentation, management and outcomes of IVH related to AVM rupture have not been clearly addressed yet. The aim of the present study was to investigate the characteristics of IVH related to AVM rupture, with particular attention paid to functional outcomes and to the impact of intraventricular fibrinolysis (IVF).

PATIENTS AND METHODS:

Between 2011 and 2015, all patients suffering from IVH admitted in two tertiary neurosurgical centers were included in a prospective register. Patient with IVH related to AVM rupture were identified (n=29) and their data retrospectively collected. Particular attention was paid on patients who received IVF. We also compared them to 29 apparied aneurysmal IVH.

RESULTS:

IVH related to AVM rupture often occurred in young patients. In most cases, intracerebral hemorrhage was associated to IVH. 17% of the patients died, and functional outcome at 6 months was similar to those with aneurysmal IVH. Interestingly, 5 patients received IVF and none experienced any rebleeding.

CONCLUSION:

IVH related to AVM rupture is a severe form of hemorrhagic stroke, with a poor neurologic prognosis. IVF seems to be safe and may be considered in this particular form of IVH.

KEYWORDS:

Arteriovenous malformation; Fibrinolysis; Intracranial aneurysm; Intraventricular hemorrhage

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