Ye Zengpanpan, Ai Xiaolin, Hu Xin, Fang Fang, You Chao
Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2017 Nov;96(45):e8544. doi: 10.1097/MD.0000000000008544.
Intraventricular hemorrhage (IVH) was associated with poor outcomes in patients with intracerebral hemorrhage. IVH had a high incidence in patients with ruptured arteriovenous malformations (AVMs). In this study, we aimed to discuss the clinical features and prognostic factors of outcomes in the patients with AVM-related IVH.From January 2010 to January 2016, we collected the data of the patients with AVM-related IVH retrospectively. The data, including clinical and radiological parameters, were collected to evaluate the clinical features. Univariate and multivariate logistic regression analyses were used to identify the prognostic factors for clinical outcomes (hydrocephalus, 6-month outcomes measured by the modified Rankin scale) in our cohort.A total of 67 eligible patients were included and 19 patients (28%) only presented with IVH. Thirty-three patients (49%) presented hydrocephalus, and 12 patients (18%) presented brain ischemia. Nineteen patients (28%) had a poor outcome after 6 months. In multivariate logistic regression, subarachnoid hemorrhage (SAH) (P = .028) was associated with hydrocephalus and higher Graeb score (P = .080) tended to increase the risk of hydrocephalus. The high Glasgow coma scale (P = .010), large hematoma volume of parenchyma (P = .006), and high supplemented Spetzler-Martin (sup-SM) score (P = .041) were independent factors of the poor outcome.IVH was common in ruptured AVMs and increased the poor outcomes in patients with the ruptured AVMs. The AVM-related IVH patients had a high incidence of hydrocephalus, which was associated with brain ischemia and SAH. Patients with lower Glasgow coma scale, lower sup-SM score, and smaller parenchymal hematoma had better long-term outcomes.
脑室内出血（IVH）与脑出血患者的不良预后相关。IVH在破裂动静脉畸形（AVM）患者中发生率较高。在本研究中，我们旨在探讨与AVM相关的IVH患者的临床特征及预后因素。
2010年1月至2016年1月，我们回顾性收集了与AVM相关的IVH患者的数据。收集包括临床和影像学参数在内的数据以评估临床特征。采用单因素和多因素逻辑回归分析确定我们队列中临床结局（脑积水，改良Rankin量表测量的6个月结局）的预后因素。
共纳入67例符合条件的患者，19例患者（28%）仅表现为IVH。33例患者（49%）出现脑积水，12例患者（18%）出现脑缺血。19例患者（28%）在6个月后预后不良。在多因素逻辑回归中，蛛网膜下腔出血（SAH）（P = 0.028）与脑积水相关，较高的Graeb评分（P = 0.080）倾向于增加脑积水风险。高格拉斯哥昏迷量表评分（P = 0.010）、较大的脑实质血肿体积（P = 0.006）和较高的补充Spetzler-Martin（sup-SM）评分（P = 0.041）是不良预后的独立因素。
IVH在破裂的AVM中常见，增加了破裂AVM患者的不良结局。与AVM相关的IVH患者脑积水发生率较高，这与脑缺血和SAH相关。格拉斯哥昏迷量表评分较低、sup-SM评分较低和脑实质血肿较小的患者长期预后较好。
