Regula J U, Schill J, Ringleb P A, Sykora M
Department of Neurology, UniversityHospital Heidelberg, Heidelberg, Germany,
Neurocrit Care. 2014 Jun;20(3):460-5. doi: 10.1007/s12028-013-9897-z.
Intracerebral hemorrhage (ICH) with intraventricular extension (IVH) is a devastating disease with a particular high mortality. In some aspects, IVH may resemble subarachnoid hemorrhage. The incidence and role of cerebral vasospasm in ICH with IVH are poorly understood. Here, we aimed to analyze the incidence and relationship of cerebral vasospasm to clinical characteristics, in-hospital mortality, and functional outcome at 3 months in patients suffering ICH with IVH.
Patients with ICH and IVH treated on a neurological intensive care unit were prospectively enrolled in a single-center observational study. Vasospasm was defined using established ultrasound criteria. Delayed cerebral ischemia (DCI) was defined as a new hypodensity on follow-up cranial CT. Functional outcome at 3 months was assessed using the modified Rankin Scale.
129 patients with ICH and IVH were screened for the study. 62 patients entered the final analysis. The incidence of significant vasospasm was 37 %. A strong trend was found for the association between all cerebral vasospasm and DCI (P = 0.046). Early (up to 48 h) vasospasm was significantly associated with a DCI (P = 0.033). Overall mortality and outcome after 3 months did not differ between the groups.
Cerebral vasospasm seems to be a frequent complication after ICH with IVH and might be associated with DCI. Larger studies are warranted to confirm this hypothesis.
伴有脑室扩展（IVH）的脑出血（ICH）是一种具有极高死亡率的毁灭性疾病。在某些方面，IVH可能类似于蛛网膜下腔出血。脑出血伴IVH时脑血管痉挛的发生率及作用尚不清楚。在此，我们旨在分析脑出血伴IVH患者脑血管痉挛的发生率及其与临床特征、住院死亡率和3个月时功能转归的关系。
前瞻性纳入在神经重症监护病房接受治疗的脑出血伴IVH患者进行单中心观察性研究。采用既定的超声标准定义血管痉挛。迟发性脑缺血（DCI）定义为随访头颅CT出现新的低密度影。采用改良Rankin量表评估3个月时的功能转归。
129例脑出血伴IVH患者被纳入本研究进行筛查。62例患者进入最终分析。严重血管痉挛的发生率为37%。发现所有脑血管痉挛与DCI之间存在强烈的关联趋势（P = 0.046）。早期（至48小时）血管痉挛与DCI显著相关（P = 0.033）。两组之间的总体死亡率和3个月后的转归无差异。
脑血管痉挛似乎是脑出血伴IVH后的常见并发症，可能与DCI有关。需要更大规模的研究来证实这一假设。
