Shapiro S A, Campbell R L, Scully T
Department of Neurosurgery, University Medical Center, Indianapolis, Indiana.
J Neurosurg. 1994 May;80(5):805-9. doi: 10.3171/jns.1994.80.5.0805.
Very little is known about the effect of computerized tomography (CT)-documented fourth intraventricular hemorrhage (IVH). An analysis of 50 patients with CT-documented fourth IVH treated between 1987 and 1992 is presented. The various etiologies included intraparenchymal hemorrhage with secondary fourth IVH (19 cases), spontaneous subarachnoid hemorrhage (18 cases), spontaneous IVH (seven cases), and trauma (six cases). Overall, 28 patients (56%) had hemorrhagic dilation of the fourth ventricle and all 28 suffered brain death, despite aggressive therapy in 79% of cases. Twenty-two patients (44%) had fourth IVH without dilation; of these, nine (41%) died and 13 (59%) experienced functional survival, despite aggressive care in 90% of cases. The survival rate was significantly worse for patients with dilation of the fourth ventricle (p < 0.01, chi-squared test). Of the 28 patients with fourth IVH associated with dilation, 25 (89%) had diffuse clot, involving the lateral and third ventricles as well, and three (11%) had isolated fourth IVH. Of the 22 patients with fourth IVH and no dilation, 13 (59%) had diffuse IVH (eight of these died and five had functional recovery) and nine (41%) had isolated fourth IVH (one died and eight had functional recovery). Diffuse ventricular clot was associated with an increased mortality rate for patients with fourth IVH and no dilation (p < 0.05). Of the 28 patients with fourth IVH associated with dilation, 24 (86%) presented with a Glasgow Coma Scale (GCS) score of 3 or 4, one with a GCS score of 6, and three with a GCS score of 13 to 15; all 28 died. For the 22 patients with fourth IVH and no dilation, nine presented with a GCS score of 3 to 5 (eight died and one had functional recovery), three had a GCS score of 6 to 8 (all three had functional survival), two had a GCS score of 9 to 12 (both had functional survival), and eight had a GCS score of 13 to 15 (one died and seven had functional survival). There was a greater chance of higher GCS scores in patients with fourth IVH and no hemorrhagic dilation (p < 0.01). Logistic regression multivariate analysis showed hemorrhagic fourth ventricular dilation to be the most significant outcome predictor (p = 0.0001), followed by GCS score (p = 0.007) and the presence of diffuse IVH (p = 0.0279).
关于计算机断层扫描（CT）记录的第四脑室出血（IVH）的影响，人们了解甚少。本文对1987年至1992年间接受治疗的50例CT记录的第四脑室出血患者进行了分析。病因多种多样，包括脑实质内出血继发第四脑室出血（19例）、自发性蛛网膜下腔出血（18例）、自发性第四脑室出血（7例）和创伤（6例）。总体而言，28例患者（56%）出现第四脑室出血性扩张，尽管79%的病例接受了积极治疗，但所有28例均发生脑死亡。22例患者（44%）出现第四脑室出血但无扩张；其中，9例（41%）死亡，13例（59%）功能存活，尽管90%的病例接受了积极治疗。第四脑室扩张患者的存活率明显更差（p<0.01，卡方检验）。在28例与扩张相关的第四脑室出血患者中，25例（89%）有弥漫性血凝块，累及侧脑室和第三脑室，3例（11%）为孤立性第四脑室出血。在22例第四脑室出血且无扩张的患者中，13例（59%）有弥漫性第四脑室出血（其中8例死亡，5例功能恢复），9例（41%）为孤立性第四脑室出血（1例死亡，8例功能恢复）。弥漫性脑室血凝块与第四脑室出血且无扩张患者的死亡率增加相关（p<0.05）。在28例与扩张相关的第四脑室出血患者中，24例（86%）格拉斯哥昏迷量表（GCS）评分为3或4分，1例评分为6分，3例评分为13至15分；所有28例均死亡。对于22例第四脑室出血且无扩张的患者，9例GCS评分为3至5分（8例死亡，1例功能恢复），3例评分为6至8分（均功能存活），2例评分为9至12分（均功能存活），8例评分为13至15分（1例死亡，7例功能存活）。第四脑室出血且无出血性扩张的患者GCS评分较高的可能性更大（p<0.01）。逻辑回归多变量分析显示，出血性第四脑室扩张是最显著的预后预测因素（p = 0.0001），其次是GCS评分（p = 0.007）和弥漫性第四脑室出血的存在（p = 0.0279）。
