Introduction

Intraventricular hemorrhage (IVH) can occur following rupture of parenchymal hemorrhage into the ventricular system (secondary IVH) or can result from disease processes either within the ventricular system or just beneath the ventricular wall (primary IVH). This chapter will concentrate on primary IVH and briefly discuss secondary IVH. IVH during the neonatal period and IVH in the presence of generalized subarachnoid hemorrhage are not discussed.

In 1881, following a review of 94 cases, Sanders (1881) coined the term primary intraventricular hemorrhage. He described the clinical syndrome as occurring in the very young and the very old. It was of rapid onset, with profound coma from the outset, with convulsions (though paralysis frequently was absent), rapidly leading to death. He further added that ‘most authors agree with the statement that extravasation of the blood into the ventricles is uniformly and rapidly fatal’. Such pessimistic views continued for half a century (Gordon, 1916). It is not surprising that such a view was common, because those earlier observations had been based on postmortem studies. Subsequent to the introduction of computed tomography (CT), non-fatal IVH has been recognized (Butler et al., 1972; De Weerd, 1979; Gates et al., 1986).

Neuroanatomic considerations

In the circulation in the subependymal or periventricular region, there is a distinct periventricular centrifugal supply of blood, with the direction of flow being from the ventricular surface toward the parenchyma for a distance of up to 1.5 cm. The periventricular arteries originate beneath the ependyma as terminal branches of the anterior and posterior choroidal arteries and of some of the striatal rami of the middle cerebral artery.