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

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.

• Authors: P A Grabb
• Journal: Neurosurgery (Neurosurgery) Vol. 43 Issue 4 Pg. 966-9 (Oct 1998) ISSN: 0148-396X [Print] United States
• PMID: 9766330 (Publication Type: Case Reports, Journal Article)

Chemical References

• Recombinant Proteins
• Tissue Plasminogen Activator

Topics

• Adolescent
• Cerebral Hemorrhage (diagnostic imaging, therapy)
• Cerebral Ventricles (injuries)
• Head Injuries, Closed (diagnostic imaging, therapy)
• Humans
• Intracranial Hypertension (therapy)
• Male
• Recombinant Proteins (administration & dosage)
• Recurrence
• Thrombolytic Therapy
• Tissue Plasminogen Activator (administration & dosage)
• Tomography, X-Ray Computed
• Ventriculostomy