The incidence of this disease accounts for 1.2% of severe traumatic brain injuries. Among severe traumatic brain injury patients undergoing CT scans, it accounts for 7.1%.

bubble_chart Etiology

Traumatic intraventricular hemorrhage can be classified into two types. The first occurs when violent force is applied to the frontal or occipital region, causing the brain tissue to move violently along the anterior-posterior direction. This generates shear deformation in the ventricular wall, tearing the blood vessels of the ependymal membrane and resulting in what is known as primary intraventricular hemorrhage. The second type arises when a traumatic intracerebral hematoma ruptures into the ventricle, leading to secondary intraventricular hemorrhage.

bubble_chart Clinical Manifestations

In addition to brain damage, increased intracranial pressure, and significant consciousness impairment, clinical manifestations also include central high fever (persisting above 40°C), rapid breathing, decerebrate rigidity, and pupillary changes, which can easily be confused with brainstem injury or hypothalamic injury. Definitive diagnosis relies on CT scans, which reveal obvious high-density shadows filling part of the ventricular system, either unilaterally or bilaterally. Cases with massive hemorrhage forming a complete ventricular cast are relatively rare.

bubble_chart Treatment Measures

This condition is often complicated by severe cerebral contusions and/or hematomas in other areas, with its harmfulness being particularly greater than that of intraventricular hemorrhage. While promptly addressing primary and secondary injuries, ventricular drainage should be performed, or after removing intracranial hematomas and contused brain tissue, the ventricles should be incised to remove blood clots causing ventricular obstruction. Typically, a small amount of intraventricular hemorrhage can be absorbed on its own, and even small blood clots can liquefy within about 10 days. Therefore, performing lumbar puncture to drain bloody cerebrospinal fluid several times can clear the cerebrospinal fluid. However, if the intraventricular hemorrhage is substantial and fills the entire ventricular system, ventricular incision or drilling for irrigation and drainage is necessary. The former is often performed during craniotomy, while the latter involves bilateral frontal horn ventricular puncture, using saline for equal-volume alternating irrigation to remove as much accumulated blood as possible. If necessary, urokinase can also be used to dissolve blood clots, thereby reducing ventricular dilation and hydrocephalus, while also alleviating compression on the hypothalamus and upper brainstem, thus preventing ischemic and hypoxic secondary damage to the gray matter nuclei in these regions.

The amount of intraventricular hemorrhage, the severity of the primary brain injury, the patient's age, and the presence of early ventricular system enlargement directly affect the prognosis, with a mortality rate ranging from 31.6% to 76.6%. Survivors often experience residual functional deficits and intellectual disabilities.