Martí-Fàbregas J, Martí-Vilalta J L
Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
Rev Neurol. 2000;31(2):187-91.
Primary intraventricular hemorrhage is non-traumatic cerebral hemorrhage limited to the ventricular system which presents on rare occasions, forming 3% of the spontaneous cerebral hemorrhages.
The diagnosis may be suspected when there is sudden onset of headache, nausea and vomiting with reduced level of consciousness. On examination there are signs of meningism, bilateral positive Babinski signs and absence of localizing neurological signs. However, cases of more subacute onset or with a normal state of consciousness are also seen. Therefore, in spite of clinical suspicion, diagnosis is made on cerebral computerized tomography. The aetiology is varied and it should be emphasized that vascular malformations cause 34% and in 21-47% no cause is found. Probably arterial hypertension is a major cause of primary intraventricular haemorrhage (38.5% in one series). Arteriography is necessary as well as computerized tomography for diagnosis of the aetiology. The prognosis is relatively good. The mortality is 29% and most survivors become asymptomatic or are left with only minor sequelae, often characterized by memory problems. In elderly patients there is a worse prognosis if there is an initial alteration in consciousness and if hydrocephaly occurs, but the prognosis does not appear to be affected by the volume of the hemorrhage. There is no specific treatment, but promising results have been obtained with intrathecal administration of fibrinolytic agents followed by external drainage.
原发性脑室内出血是指局限于脑室系统的非创伤性脑出血，这种情况很少见，占自发性脑出血的3%。
当突然出现头痛、恶心、呕吐且意识水平下降时，可能会怀疑该病。检查时会有脑膜刺激征、双侧巴宾斯基征阳性且无定位性神经体征。然而，也可见到起病较亚急性或意识状态正常的病例。因此，尽管有临床怀疑，但仍需通过脑部计算机断层扫描来确诊。病因多种多样，需要强调的是，血管畸形导致的占34%，21% - 47%的病例病因不明。动脉高血压可能是原发性脑室内出血的主要原因（在一组病例中占38.5%）。为明确病因，动脉造影以及计算机断层扫描都是必要的。预后相对较好。死亡率为29%，大多数幸存者无症状或仅留下轻微后遗症，常表现为记忆问题。在老年患者中，如果初始意识有改变且发生脑积水，预后较差，但预后似乎不受出血量的影响。目前尚无特效治疗方法，但鞘内注射纤溶药物后行外部引流已取得了有前景的结果。
