gms | German Medical Science

Objective: Intraventricular hemorrhage (IVH) is a common complication of aneurysmal subarachnoid hemorrhage (SAH). We aimed to identify independent risk factors for IVH development and its severity during aneurysm rupture.

Method: 625 SAH patients treated at our institution between January 2005 and December 2012 were included. The severity of IVH was assessed according to the original Graeb score. Clinical and radiographic features of patients present at the bleeding event were tested as potential risk factors for IVH. Moreover, the characteristics of IVH were correlated with the clinical course and outcome.

Results: IVH was present in 206 patients (33%) and was independently predicted by patient’s age (p=0.001, odds ratio (OR)=1.02/year of age increase), aneurysm size (p=0.031, OR=1.05/mm increase) and location (p<0.0001, OR=3.2 for aneurysms of posterior circulation). The severity of IVH was predicted by aneurysm size (p=0.023) and location (higher severity for aneurysms of anterior circulation, p=0.01). The presence of IVH (p<0.0001, OR=4.1) and IVH severity of >3 points on the Graeb score (p=0.029, OR=3.4) were independently associated with poor outcome. Shunt dependency was associated only with the occurrence of IVH (p<0.0001, OR=2.8) while the severity of IVH only influenced the timing of shunt placement (p=0.0156).

Conclusions: Increasing age, aneurysm size and location in the posterior circulation are the main risk factors for occurrence of aneurysmal IVH, which is independently associated with poor outcome. The severity of IVH, however, is higher if the aneurysm is located in the anterior circulation and has impact on functional outcome, but not on shunt dependency.