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How to diagnose intraventricular bleeding through CT? The story behind medical imaging!
Intraventricular hemorrhage (IVH), is a type of bleeding in the choroid plexus in the brain. The cerebrospinal fluid is produced and circulated in the ventricular system and then flows to the subarachnoid space.This condition may be caused by trauma or hemorrhagic stroke.Research shows that about 30% of intraventricular bleeding is primary, which is usually caused by choroidal plexus tumors, vascular malformations or aneurysms, while 70% of intraventricular bleeding is secondary, usually from existing brains. Internal or subarachnoid hemorrhage enlarges.Intraventricular bleeding occurs in approximately 35% of patients with moderate to severe traumatic brain injury, further suggesting that this bleeding is often accompanied by extensive concurrent injuries and therefore, the prognosis is rarely good.
Symptoms
Adult
The symptoms of intraventricular bleeding are similar to other intracerebral bleeding, usually including sudden headaches, nausea and vomiting, accompanied by changes in consciousness and consciousness levels.Local neurological signs may be mild or missing, but local and/or systemic epilepsy may occur.Discoloration (yellowing) of cerebrospinal fluid is also a common feature.
Baby
Some babies may have no obvious symptoms, while others may experience difficult-to-detect abnormalities in consciousness, muscle tone, breathing, eye movement and body movement.
causes
Adult
Intraventricular bleeding in adults is usually caused by trauma or hemorrhagic stroke.
Baby
Premature babies and very low birth weight babies are at higher risk.Intraventricular bleeding in premature babies is mostly caused by the embryonic matrix, while full-term babies usually come from the choroidal plexus.This condition is particularly common in infants with premature birth and low birth weight and is not often caused by trauma.On the contrary, it is believed to be related to ventilation and blood flow changes in the brain's micro blood vessels, which are manifestations of fragility in the developing midbrain.
Diagnosis
The most effective way to diagnose intraventricular bleeding is to use a CT scan, which clearly displays the blood in the ventricle.
Baby
For different degrees of intraventricular hemorrhage, it is usually divided into four levels:
- Grade I - only bleeding to embryonic matrix
- Level II - Hemorrhage extends to the ventricle, but no ventricle dilation
- Level III - Ventricular enlargement due to hemorrhage
- Level IV - Hemorrhage extends to brain tissue around the ventricle
Grades I and II are the most common, usually without subsequent complications, while grades III and IV are the most severe, potentially leading to long-term brain damage in the infant.
Preventive measures
Single steroid administration from 24 to 33 weeks during pregnancy showed a reduced risk of intraventricular bleeding during neonatal periods.Head placement in premature babies is also considered a way to reduce the risk of bleeding, but further research is still needed to determine its effectiveness.
Treatment
Treatment mainly focuses on observation and chooses hospitalization services or neurointensive care based on the patient's consciousness status.Special attention should be paid to the monitoring of intracranial pressure (ICP). If necessary, ventricular catheters and drugs can be used to manage, including maintaining ICP, blood pressure and coagulation function.In more severe cases, external ventricular drainage may be required to help control ICP and discharge bleeding, and in extreme cases, craniotomy may be required.
Baby
For neonates, different treatment options have been available, such as diuretic therapy, repeated lumbar puncture and recently developed new treatments (DRIFTs) to reduce high incidence and mortality.More high-quality randomized controlled studies are needed to determine the safety and effectiveness of preventive heparin and anticoagulation therapy.
Prognosis
For infants, embryonic stromal hemorrhage is associated with cerebral palsy, cognitive impairment, and ventricular dilation.With the advancement of medical technology, the survival of premature babies has improved. Many premature babies no longer face severe cerebral palsy. About 15% are expected to develop cerebral palsy, while 27% are between 18 and 24 months old. You may face significant neurological disorders later.The prognosis is more pessimistic for intraventricular hemorrhage caused by hypertension, especially when accompanied by increased intracranial pressure; this may lead to fatal brain hernia.
Conclusion
Study shows that the incidence of intraventricular bleeding is the highest in the first week of birth. Is it possible for people to improve early diagnosis and subsequent treatment effects through more advanced imaging techniques when dealing with this challenge?
