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Neurosurgery. 1998 Oct;43(4):966-9.

Traumatic intraventricular hemorrhage treated with intraventricular recombinant-tissue plasminogen activator: technical case report.

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1
Division of Neurosurgery, University of Alabama at Birmingham, Children's Hospital of Alabama, 35233, USA.

Abstract

OBJECTIVE AND IMPORTANCE:

Traumatic intraventricular hemorrhage (IVH) can result in association with acute obstructive hydrocephalus, repetitive malfunction of external ventricular drains (EVDs), and uncontrollable increased intracranial pressure. We report a case showing the safe and effective use of intraventricular recombinant-tissue plasminogen activator in a child with severe brain injury and acute hydrocephalus from IVH.

CLINICAL PRESENTATION:

A 15-year-old male patient presented to us after a motor vehicle accident with bilateral extensor posturing, intracerebral and IVH, and acute obstructive hydrocephalus.

INTERVENTION:

A right EVD was placed and functioned only transiently. A left EVD was placed and functioned only transiently. Because of the inability to maintain ventricular drainage, rising intracranial pressure, and worsening clinical status, 5 mg of recombinant-tissue plasminogen activator was injected through each EVD. Excellent EVD function was obtained quickly, with control of intracranial pressure and improvement in clinical status and without hemorrhagic complication.

CONCLUSION:

With obstructive hydrocephalus secondary to acute traumatic IVH that cannot be controlled with EVD because of recurrent obstruction from intraventricular blood, intraventricular recombinant-tissue plasminogen activator can be effective and safe, despite preexisting multiple hemorrhagic intracranial injuries.

PMID:
9766330
[Indexed for MEDLINE]
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