Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase

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✓ Six patients with severe intraventricular hemorrhage were treated with direct intraventricular infusion of urokinase. In each case, hemorrhage extended into all ventricular chambers, and a cast formation and expansion of the third and fourth ventricles were found. Immediately after the therapy was started (within 7 days from onset of symptoms), reduction of intraventricular hematoma volume was observed on computerized tomography. On average, both the third and fourth ventricles became clear on the third day after hemorrhage; there was one exception, a case of ruptured aneurysm. Five of the six patients showed excellent or good outcome, although two developed delayed hydrocephalus. No infection or rebleeding was observed. The outcome in a retrospectively studied group of five patients not treated with urokinase is also reported. The authors conclude that this relatively easy method of treatment will greatly improve the prognosis of severe intraventricular hemorrhage.

Article Information

Address reprint requests to: Masaaki Usui, M.D., Department of Neurosurgery, Aizu Central Hospital, 1–1 Tsurugamachi, Aizuwakamatsu-shi, Fukushima-ken 965, Japan.

© AANS, except where prohibited by US copyright law.

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    Changes of intraventricular hematoma profile demonstrated on computerized tomography scans during intraventricular urokinase infusion therapy in six patients. Immediate and rapid decrease of the Graeb score of hematoma severity was observed in all cases except the patient with ruptured aneurysm.

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    Computerized tomography findings in Case 1 before and after urokinase infusion therapy. Almost complete resolution of the hematoma in both the third and fourth ventricles can be observed on the Day 2 scans.

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    Computerized tomography findings in Case 3 before and after urokinase infusion therapy. Opening and clearance of both the third and fourth ventricles can be observed on the Day 3 scans.

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