Wang Arthur, Ray Abhishek, Hu Yin C
Department of Neurosurgery, New York Medical College, Valhalla, New York, USA.
Department of Neurological Surgery, University Hospitals, Cleveland, Ohio, USA.
BMJ Case Rep. 2016 May 24;2016:bcr2016012408. doi: 10.1136/bcr-2016-012408.
Intraventricular haemorrhage (IVH) secondary to arteriovenous malformation (AVM) rupture carries significant morbidity and mortality. External ventricular drainage of IVH is frequently complicated by thrombus formation within the ventricular catheter and therefore often unsuccessful at treating hydrocephalus in this setting. Intraventricular administration of recombinant tissue-type plasminogen activator (rtPA) has proved successful in the treatment of spontaneous panventricular haemorrhage. However, usage of rtPA is contraindicated in the setting of a ruptured AVM or aneurysm in which the bleeding source has not been secured. There are only a few reports of intraventricular thrombolysis in the treatment of IVH from AVM rupture. We present the case of successful application of rtPA to treat IVH after endovascularly securing the haemorrhage site of the AVM. Intraventricular thrombolysis remains an option for the treatment of IVH in the setting of AVM rupture and should be considered on a case-by-case basis.
动静脉畸形（AVM）破裂继发的脑室内出血（IVH）具有显著的发病率和死亡率。IVH的脑室外引流常常因脑室导管内形成血栓而复杂化，因此在这种情况下治疗脑积水往往不成功。脑室内给予重组组织型纤溶酶原激活剂（rtPA）已被证明在治疗自发性全脑室出血方面是成功的。然而，在AVM或动脉瘤破裂且出血源未得到控制的情况下，rtPA的使用是禁忌的。关于AVM破裂导致的IVH采用脑室内溶栓治疗的报道仅有几例。我们报告了在血管内确保AVM出血部位安全后成功应用rtPA治疗IVH的病例。脑室内溶栓仍然是AVM破裂导致的IVH的一种治疗选择，应根据具体情况进行考虑。
