Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Transl Stroke Res. 2012 Jul;3(Suppl 1):25-38. doi: 10.1007/s12975-012-0182-9.
Intraventricular hemorrhage (IVH) is a cause of significant morbidity and mortality and is an independent predictor of a worse outcome in intracerebral hemorrhage (ICH) and germinal matrix hemorrhage (GMH). IVH may result in both injuries to the brain as well as hydrocephalus. This paper reviews evidence on the mechanisms and potential treatments for IVH-induced hydrocephalus. One frequently cited theory to explain hydrocephalus after IVH involves obliteration of the arachnoid villi by microthrombi with subsequent inflammation and fibrosis causing CSF outflow obstruction. Although there is some evidence to support this theory, there may be other mechanisms involved, which contribute to the development of hydrocephalus. It is also unclear whether the causes of acute and chronic hydrocephalus after hemorrhage occur via different mechanisms; mechanical obstruction by blood in the former, and inflammation and fibrosis in the latter. Management of IVH and strategies for prevention of brain injury and hydrocephalus are areas requiring further study. A better understanding of the pathogenesis of hydrocephalus after IVH, may lead to improved strategies to prevent and treat post-hemorrhagic hydrocephalus.
脑室内出血（IVH）是导致高发病率和高死亡率的原因，并且是脑出血（ICH）和脑室内出血（GMH）预后不良的独立预测因素。IVH 可导致脑损伤和脑积水。本文综述了 IVH 引起脑积水的机制和潜在治疗方法的证据。一种常被引用的理论认为，蛛网膜绒毛被微血栓阻塞，随后发生炎症和纤维化，导致 CSF 流出受阻，从而解释了 IVH 后发生脑积水的机制。尽管有一些证据支持这一理论，但可能还有其他机制参与其中，导致脑积水的发生。此外，出血后急性和慢性脑积水的发生机制是否不同，即前者是由于血液的机械性阻塞，后者是由于炎症和纤维化，目前尚不清楚。IVH 的治疗和预防脑损伤和脑积水的策略是需要进一步研究的领域。更好地了解 IVH 后脑积水的发病机制，可能会为预防和治疗出血后脑积水提供更好的策略。
