Primary intraventricular hemorrhage (IVH) is a rare type of hemorrhage where bleeding occurs in the ventricular system of the brain without an associated brain parenchymal hemorrhage. It accounts for less than 4% of all IVH cases. The causes include vascular malformations like arteriovenous malformations in around 25-45% of cases. Diagnosis involves CT, MRI, or cerebral angiography. Treatment focuses on managing any underlying causes and addressing hydrocephalus which occurs in around 40% of primary IVH patients through surgical shunt placement.

1. PRIMARY
INTRAVENTRICULAR HAEMORRHAGE
(PRIMARY IVH)
Ade Wijaya, MD – July 2018

2. OUTLINE:
 Ventricular system
 Introduction
 Causes and predisposing factors
 Diagnosis
 Differential diagnosis
 Treatment
 Conclusion

4. INTRODUCTION
 IVH  usually secondary to intraparenchymal
haemorrhage
 Isolated IVH is rare (< 4%)
 First defined by Sanders as bleeding in the
ventricular system without a discernable
parenchymal component or arising within 15 mm
from the ventricular wall
Flint AC, Roebken A, Singh V. Primary intraventricular hemorrhage: yield of diagnostic angiography and clinical outcome. Neurocrit Care 2008; 8 : 330–6.
Srivastava T, Sannegowda RB, Satija V, Jain RS, Tejwani S, Mathur T. Primary intraventricular hemorrhage: clinical features, risk factors, etiology, and yield of diagnostic
cerebral angiography. Neurology India. 2014 Mar 1;62(2):144.

5. CAUSES & PREDISPOSING FACTORS
Barnaure I, Liberato AC, Gonzalez RG, Romero JM. Isolated intraventricular haemorrhage in adults. The British journal of radiology. 2016 Dec 20;90(1069):20160779.

6. CAUSES & PREDISPOSING FACTORS
Srivastava T, Sannegowda RB, Satija V, Jain RS, Tejwani S, Mathur T. Primary intraventricular hemorrhage: clinical features, risk factors, etiology, and yield of diagnostic
cerebral angiography. Neurology India. 2014 Mar 1;62(2):144.

7. CAUSES & PREDISPOSING FACTORS
 Most cases due to vascular malformations.
 25-45 % unknown etology. Probably due small to
vascular malformations, invisible with angiography.
 Work up with MRI / high resolution CT
Marti-Fabregas J, Piles S, Guardia E, MartiVilalta JL. Spontaneous primary intraventricular hemorrhage: clinical data, etiology and outcome. J Neurol 1999; 246 : 287–91.
Passero S, Ulivelli M, Reale F. Primary intraventricular haemorrhage in adults. Acta Neurol Scand 2002; 105 :115–19.
Giray S, Sen O, Sarica FB, Tufan K, Karatas M, Goksel BK, et al. Spontaneous primary intraventricular hemorrhage in adults: clinical data, etiology and outcome. Turk
Neurosurg 2009;19: 338–44.

8. DIAGNOSIS
 Clinical and physical examination
 CT/CT angiography
 MRI/MR angiography
 Catheter angiography
Barnaure I, Liberato AC, Gonzalez RG, Romero JM. Isolated intraventricular haemorrhage in adults. The British journal of radiology. 2016 Dec 20;90(1069):20160779.

9. DIFFERENTIAL DIAGNOSIS
 Intraventricular pus
 Colloid cysts
 Hyperdense tumoral lesions (e.g. Lymphoma)
Barnaure I, Liberato AC, Gonzalez RG, Romero JM. Isolated intraventricular haemorrhage in adults. The British journal of radiology. 2016 Dec 20;90(1069):20160779.

10. TREATMENT
 Treat underlying etiologies
 Conservative management
 Hydrocephalus in around 40 % patients  shunting
Srivastava T, Sannegowda RB, Satija V, Jain RS, Tejwani S, Mathur T. Primary intraventricular hemorrhage: clinical features, risk factors, etiology, and yield of diagnostic
cerebral angiography. Neurology India. 2014 Mar 1;62(2):144.

11. CONCLUSION
 Primary IVH is rare
 Hypertension and AVM
 Cerebral angiography