Dull Christopher, Torbey Michel T
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neurocrit Care. 2005;3(2):150-2. doi: 10.1385/NCC:3:2:150.
Cerebral vasospasm remains a major complication associated with aneurysmal subarachnoid hemorrhage. Although several case reports have demonstrated that intraventricular hemorrhage (IVH) related to a ruptured arteriovenous malformation can result in vasospasm in the absence of subarachnoid hemorrhage, to our knowledge, this is the first case report of cerebral vasospasm associated with primary IVH.
A 44-year-old female was admitted with cerebellar infarction secondary to left posteroinferior cerebellar artery occlusion. Her hospital stay was complicated by primary IVH. Three days after her IVH, she became disoriented and developed a peculiar interest in counting numbers. This behavioral change was associated with an increase in cerebral blood flow velocity in the anterior circulation. Middle cerebral artery M1 velocity almost doubled from 65 to 130 cm/second. Her symptoms resolved with initiation of hypervolemia, hypertension, and hemodilution (triple H) therapy.
Cerebral vasospasm may contribute to the comorbidities of IVH. Routine transcranial Doppler may be warranted for screening of cerebral vasospasm in IVH patients.
脑血管痉挛仍然是动脉瘤性蛛网膜下腔出血的主要并发症。尽管有几例病例报告表明，与破裂动静脉畸形相关的脑室内出血（IVH）在无蛛网膜下腔出血的情况下可导致血管痉挛，但据我们所知，这是首例与原发性IVH相关的脑血管痉挛病例报告。
一名44岁女性因左小脑后下动脉闭塞继发小脑梗死入院。她住院期间并发原发性IVH。IVH三天后，她出现定向障碍，并对计数产生了特殊兴趣。这种行为改变与前循环脑血流速度增加有关。大脑中动脉M1段速度从65厘米/秒几乎翻倍至130厘米/秒。通过启动高血容量、高血压和血液稀释（三H）疗法，她的症状得到缓解。
脑血管痉挛可能是IVH合并症的原因之一。对于IVH患者，可能有必要常规进行经颅多普勒检查以筛查脑血管痉挛。
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