Initial intraventricular involvement and early intracerebral hematoma retraction: The “ventricular washout”
Issued Date
2025-01-01
Resource Type
ISSN
23969873
eISSN
23969881
Scopus ID
2-s2.0-105002651059
Journal Title
European Stroke Journal
Rights Holder(s)
SCOPUS
Bibliographic Citation
European Stroke Journal (2025)
Suggested Citation
Pensato U., Kaveeta C., Tanaka K., Ospel J.M., AlShamrani M.A., Horn M., Dowlatshahi D., Kulkarni G., Teleg E., Al Sultan A.S., Kasickova L., Ohara T., Ojha P., Marzoughi S., Menon B.K., Goyal M., Demchuk A.M. Initial intraventricular involvement and early intracerebral hematoma retraction: The “ventricular washout”. European Stroke Journal (2025). doi:10.1177/23969873251330186 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/109661
Title
Initial intraventricular involvement and early intracerebral hematoma retraction: The “ventricular washout”
Author's Affiliation
Siriraj Hospital
L’École de médecine
Humanitas University
Kyoto Prefectural University of Medicine
Ostravská Univerzita v Ostrave
Humanitas Research Hospital
King Faisal Specialist Hospital & Research Centre
National Institute of Mental Health and Neuro Sciences
The University of British Columbia
University of Calgary
L’École de médecine
Humanitas University
Kyoto Prefectural University of Medicine
Ostravská Univerzita v Ostrave
Humanitas Research Hospital
King Faisal Specialist Hospital & Research Centre
National Institute of Mental Health and Neuro Sciences
The University of British Columbia
University of Calgary
Corresponding Author(s)
Other Contributor(s)
Abstract
Introduction: Intraventricular hematoma (IVH) occurs in approximately 40% of acute intracerebral hemorrhage (ICH) patients and is significantly associated with worse clinical outcomes. According to cerebrospinal fluid dynamics, some blood within the ventricles may circulate through the subarachnoid spaces, leading to its apparent “disappearance” on follow-up imaging. We aim to investigate the association between initial IVH involvement and significant early ICH retraction at follow-up imaging. Methods: Data are from the MCAHP (Multiphase CT Angiography Hematoma Prediction) Study, which included consecutive patients with acute ICH investigated with multimodal CT imaging. Patients who underwent surgery before follow-up imaging were excluded. IVH severity was assessed using the IVH score. The primary outcome was significant early ICH retraction, defined as volume decrease (⩾3 ml or ⩾15%) between the initial and follow-up scans. Secondary outcomes included early absolute and relative ICH decrease. Associations between outcomes and initial IVH involvement or IVH score were assessed with logistic regression adjusted for age, baseline NIHSS, initial ICH volume, and onset-to-CT time. Results: Overall, 177 ICH patients were included. The median age was 71 years (IQR = 59–80), 71 (40.1%) patients were female, and 64 (36.2%) presented with initial IVH involvement. Patients with initial IVH, compared to those without, had a larger initial ICH volume (28.5 ml [IQR = 12.7–52.5] vs. 18.9 ml [IQR = 8.1–30.6], p < 0.001) and different ICH location (deep = 54.7% vs 47.8%; lobar = 35.9% vs 46.0%; infratentorial = 7.3% vs 6.2%; p < 0.001). Early ICH retraction was observed in 33 (18.6%) patients: 21 (32.8%) with initial IVH and 10 (10.6%) without initial IVH. There was a significant association between early ICH retraction and initial IVH involvement (adjusted odds ratio [aOR] 4.02 [95% CI = 1.72–9.41]) and IVH score (aOR 1.14 [95% CI = 1.05–1.23] per 1-point increase). Similar results were observed for secondary outcomes. Conclusion: Initial IVH involvement is associated with early ICH retraction – “intraventricular washout.” This might result in an underestimation of hematoma expansion occurrence and severity in these patients, with potential implications when evaluating the predictive performance of hematoma expansion markers/scores and the radiological efficacy of hemostatic treatments.