• Jens Witsch, Eliza Bruce, Emma Meyers, Angela Velazquez, J Michael Schmidt, Sureerat Suwatcharangkoon, Sachin Agarwal, Soojin Park, M Cristina Falo, E Sander Connolly, and Jan Claassen.
• From the Division of Critical Care Neurology, Department of Neurology (J.W., E.M., A.V., J.M.S., S.S., S.A., S.P., M.C.F., J.C.), and Department of Neurosurgery (E.B., S.A., S.P., E.S.C., J.C.), Columbia University, College of Physicians and Surgeons, New York, NY; the Center for Stroke Research Berlin (CSB) (J.W.), Charité University Medicine, Berlin, Germany; and Ramathibodi Hospital (S.S.), Mahidol University, Bangkok, Thailand.
• Neurology. 2015 Mar 10;84(10):989-94.

ObjectiveTo evaluate whether delayed appearance of intraventricular hemorrhage (dIVH) represents an independent entity from intraventricular hemorrhage (IVH) present on admission CT or is primarily related to the time interval between symptom onset and admission CT.MethodsA total of 282 spontaneous intracerebral hemorrhage (ICH) patients, admitted February 2009-March 2014 to the neurological intensive care unit of a tertiary care university hospital, were prospectively enrolled in the ICH Outcomes Project. Multivariate logistic regression was used to determine associations with acute mortality and functional long-term outcome (modified Rankin Scale).ResultsA cohort of 282 ICH patients was retrospectively studied: 151 (53.5%) had intraventricular hemorrhage on initial CT scan (iIVH). Of the remaining 131 patients, 19 (14.5%) developed IVH after the initial CT scan (dIVH). The median times from symptom onset to admission CT were 1.1, 6.0, and 7.4 hours for the dIVH, iIVH, and no IVH groups (Mann-Whitney U test, dIVH vs iIVH, p < 0.001) and median time from onset to dIVH detection was 7.2 hours. The increase in ICH volume following hospital admission was larger in dIVH than in iIVH and no IVH patients (mean 17.6, 0.2, and 0.4 mL). After controlling for components of the ICH score and hematoma expansion, presence of IVH on initial CT was associated with discharge mortality and poor outcome at 3, 6, and 12 months, but dIVH was not associated with any of the outcome measures.ConclusionsIn ICH patients, associated IVH on admission imaging is commonly encountered and is associated with poor long-term outcome. In contrast, dIVH on subsequent scans is far less common and does not appear to portend worse outcome.© 2015 American Academy of Neurology.

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