Intraventricular Hemorrhage

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Tammy Swails - One of the best experts on this subject based on the ideXlab platform.

Daniel G. Batton - One of the best experts on this subject based on the ideXlab platform.

Issam A. Awad - One of the best experts on this subject based on the ideXlab platform.

  • Intracranial Hypertension and Cerebral Perfusion Pressure Insults in Adult Hypertensive Intraventricular Hemorrhage: Occurrence and Associations With Outcome
    Critical care medicine, 2019
    Co-Authors: Wendy C. Ziai, Carol B. Thompson, Steven Mayo, Nichol Mcbee, William D. Freeman, Rachel Dlugash, Natalie Ullman, Yi Hao, Karen Lane, Issam A. Awad
    Abstract:

    Objectives:Elevated intracranial pressure and inadequate cerebral perfusion pressure may contribute to poor outcomes in hypertensive Intraventricular Hemorrhage. We characterized the occurrence of elevated intracranial pressure and low cerebral perfusion pressure in obstructive Intraventricular hemo

  • permanent csf shunting after Intraventricular Hemorrhage in the clear iii trial
    Neurology, 2017
    Co-Authors: Santosh B Murthy, Issam A. Awad, Sagi Harnof, Francois Aldrich, Mark R Harrigan, Jack Jallo, Jeanlouis Caron, Judy Huang, Paul J Camarata, Lucia Rivera Lara
    Abstract:

    Objective: To study factors associated with permanent CSF diversion and the relationship between shunting and functional outcomes in spontaneous Intraventricular Hemorrhage (IVH). Methods: Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage (CLEAR III), a randomized, multicenter, double-blind, placebo-controlled trial, was conducted to determine if pragmatically employed external ventricular drainage (EVD) plus Intraventricular alteplase improved outcome, in comparison to EVD plus saline. Outcome measures were predictors of shunting and blinded assessment of mortality and modified Rankin Scale at 180 days. Results: Among the 500 patients with IVH, CSF shunting was performed in 90 (18%) patients at a median of 18 (interquartile range [IQR] 13–30) days. Patient demographics and IVH characteristics were similar among patients with and without shunts. In the multivariate analysis, black race (odds ratio [OR] 1.98; 95% confidence interval [CI] 1.18–3.34), duration of EVD (OR 1.10; CI 1.05–1.15), placement of more than one EVD (OR 1.93; CI 1.13–3.31), daily drainage CSF per 10 mL (OR 1.07; CI 1.04–1.10), and intracranial pressure >30 mm Hg (OR 1.70; CI 1.09–2.88) were associated with higher odds of permanent CSF shunting. Patients who had CSF shunts had similar odds of 180-day mortality, while survivors with shunts had increased odds of poor functional outcome, compared to survivors without shunts. Conclusions: Among patients with spontaneous IVH requiring emergency CSF diversion, those with early elevated intracranial pressure, high CSF output, and placement of more than one EVD are at increased odds of permanent ventricular shunting. Administration of Intraventricular alteplase, early radiographic findings, and CSF measures were not useful predictors of permanent CSF diversion.

  • abstract 215 evaluation of intracranial pressure and cerebral perfusion pressure in the clot lysis evaluating accelerated resolution of Intraventricular Hemorrhage trial clear iii
    Stroke, 2016
    Co-Authors: Wendy C. Ziai, Steven Mayo, Nichol Mcbee, William D. Freeman, Rachel Dlugash, Karen Lane, Issam A. Awad, Malathi Ram, Richard E Thompson, Daniel F Hanley
    Abstract:

    Background: Elevated intracranial pressure (ICP) and inadequate cerebral perfusion pressure (CPP) are mechanisms causing poor outcomes in spontaneous Intraventricular Hemorrhage (IVH). We character...

  • occurrence and impact of intracranial pressure elevation during treatment of severe Intraventricular Hemorrhage
    Critical Care Medicine, 2012
    Co-Authors: Wendy C. Ziai, Carol B. Thompson, Karen Lane, Issam A. Awad, Eric Melnychuk, Daniel F Hanley
    Abstract:

    Objectives:Elevated intracranial pressure is one of the proposed mechanisms leading to poor outcomes in patients with Intraventricular Hemorrhage. We sought to characterize the occurrence and significance of intracranial hypertension in severe Intraventricular Hemorrhage requiring extraventricular d

  • ventricular catheter location and the clearance of Intraventricular Hemorrhage
    Neurosurgery, 2012
    Co-Authors: Jennifer Jaffe, Wendy C. Ziai, Daniel F Hanley, Eric Melnychuk, John Muschelli, Timothy C Morgan, Issam A. Awad
    Abstract:

    BACKGROUND There is no consensus regarding optimal position of an external ventricular drain (EVD) with regard to clearance of Intraventricular Hemorrhage (IVH). OBJECTIVE To assess the hypothesis that EVD laterality may influence the clearance of blood from the ventricular system with and without administration of thrombolytic agent. METHODS The EVD location was assessed in 100 patients in 2 Clot Lysis Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR IVH) phase II trials assessing the safety and dose optimization of thrombolysis through the EVD to accelerate the clearance of obstructive IVH. Laterality of catheter was correlated with clearance rates. RESULTS Clearance of IVH over the first 3 days was significantly greater when thrombolytic compared with placebo was administered regardless of catheter laterality (P < .005; 95% confidence interval, -14.0 to -4.14 for contralateral EVD and -24.7 to -5.44 for ipsilateral EVD). When thrombolytic was administered, there was a trend toward more rapid clearance of total IVH through an EVD placed on the side of dominant Intraventricular blood compared with an EVD on the side with less blood (P = .09; 95% confidence interval, -9.62 to 0.69). This was not true when placebo was administered. Clearance of third and fourth ventricular blood was unrelated to EVD laterality. CONCLUSION It is possible that placement of EVD may be optimized to enhance the clearance of total IVH if lytic agents are used. Catheters on either side can clear the third and fourth ventricles with equal efficiency.

Shoo K Lee - One of the best experts on this subject based on the ideXlab platform.

Salvador Cruzflores - One of the best experts on this subject based on the ideXlab platform.

  • low dose recombinant tissue type plasminogen activator enhances clot resolution in brain Hemorrhage the Intraventricular Hemorrhage thrombolysis trial
    Stroke, 2011
    Co-Authors: Neal J Naff, Michael A Williams, Penelope M Keyl, Stanley Tuhrim, Ross M Bullock, Stephan A Mayer, William M Coplin, Raj K Narayan, Stephen J Haines, Salvador Cruzflores
    Abstract:

    Background and Purpose—Patients with intracerebral Hemorrhage and Intraventricular Hemorrhage have a reported mortality of 50% to 80%. We evaluated a clot lytic treatment strategy for these patients in terms of mortality, ventricular infection, and bleeding safety events, and for its effect on the rate of Intraventricular clot lysis. Methods—Forty-eight patients were enrolled at 14 centers and randomized to treatment with 3 mg recombinant tissue-type plasminogen activator (rtPA) or placebo. Demographic characteristics, severity factors, safety outcomes (mortality, infection, bleeding), and clot resolution rates were compared in the 2 groups. Results—Severity factors, including admission Glasgow Coma Scale, intracerebral Hemorrhage volume, Intraventricular Hemorrhage volume, and blood pressure were evenly distributed, as were adverse events, except for an increased frequency of respiratory system events in the placebo-treated group. Neither intracranial pressure nor cerebral perfusion pressure differed sub...

  • low dose recombinant tissue type plasminogen activator enhances clot resolution in brain Hemorrhage the Intraventricular Hemorrhage thrombolysis trial
    Stroke, 2011
    Co-Authors: Neal J Naff, Michael A Williams, Penelope M Keyl, Stanley Tuhrim, Ross M Bullock, Stephan A Mayer, William M Coplin, Raj K Narayan, Stephen J Haines, Salvador Cruzflores
    Abstract:

    Background and Purpose— Patients with intracerebral Hemorrhage and Intraventricular Hemorrhage have a reported mortality of 50% to 80%. We evaluated a clot lytic treatment strategy for these patients in terms of mortality, ventricular infection, and bleeding safety events, and for its effect on the rate of Intraventricular clot lysis. Methods— Forty-eight patients were enrolled at 14 centers and randomized to treatment with 3 mg recombinant tissue-type plasminogen activator (rtPA) or placebo. Demographic characteristics, severity factors, safety outcomes (mortality, infection, bleeding), and clot resolution rates were compared in the 2 groups. Results— Severity factors, including admission Glasgow Coma Scale, intracerebral Hemorrhage volume, Intraventricular Hemorrhage volume, and blood pressure were evenly distributed, as were adverse events, except for an increased frequency of respiratory system events in the placebo-treated group. Neither intracranial pressure nor cerebral perfusion pressure differed substantially between treatment groups on presentation, with external ventricular device closure, or during the active treatment phase. Frequency of death and ventriculitis was substantially lower than expected and bleeding events remained below the prespecified threshold for mortality (18% rtPA; 23% placebo), ventriculitis (8% rtPA; 9% placebo), symptomatic bleeding (23% rtPA; 5% placebo, which approached statistical significance; P =0.1). The median duration of dosing was 7.5 days for rtPA and 12 days for placebo. There was a significant beneficial effect of rtPA on rate of clot resolution. Conclusions— Low-dose rtPA for the treatment of intracerebral Hemorrhage with Intraventricular Hemorrhage has an acceptable safety profile compared to placebo and historical controls. Data from a well-designed phase III clinical trial, such as CLEAR III, will be needed to fully evaluate this treatment. Clinical Trial Registration— Participant enrollment began before July 1, 2005.

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