naa a22 4500 510799361 CHVBK 20180411083348.0 cr unu---uuuuu 180411e20130801xx s 000 0 eng 10.1007/s12028-012-9713-1 doi (NATIONALLICENCE)springer-10.1007/s12028-012-9713-1 Safety of Intraventricular Hemorrhage (IVH) Thrombolysis Based on CT Localization of External Ventricular Drain (EVD) Fenestrations and Analysis of EVD Tract Hemorrhage [Elektronische Daten] [Daniel Jackson, Alden Patel, Robert Darracott, Ricardo Hanel, William Freeman, Daniel Hanley] Background: The purpose of the study is to review the CT findings associated with ventriculostomy placement in regards to the safety of an EVD plus recombinant tissue plasminogen activator (rt-PA) for IVH. Methods: A retrospective review was conducted for patients receiving intraventricular rt-PA for IVH from January 2004 to September 2009. Safety was assessed by the presence of EVD tract hemorrhage by CT at baseline after EVD placement, worsening hemorrhage after rt-PA, and CSF infection. IVH volumetrics were assessed by the Le Roux score and outcomes by Glasgow Outcome Scale and modified Rankin Scale. Results: Twenty-seven patients received rt-PA for IVH. Median dose was 2mg (range 0.3-8) and a median of two doses (range 1-17) were given. Worsening EVD catheter tract hemorrhage after rt-PA was 46.7%, with a significantly higher incidence of worsening tract hemorrhage seen with incorrectly placed EVDs (p=0.04). IVH hematoma burden decreased by a median Le Roux score of 10 (range 3-16) prior to rt-PA to 4 (range 0-16) after rt-PA. There were no central nervous system bacterial infections. Conclusion: Intraventricular rt-PA appears to be relatively safe especially when all EVD fenestrations are within the ventricle and reduces IVH burden similar to other studies. We describe a CT-based EVD tract hemorrhage grading scale to evaluate EVD tract hemorrhage before and after thrombolysis, and a bone-window technique to evaluate EVD fenestrations prior to IVH thrombolysis. Further research is needed evaluating these imaging techniques in regard to intraventricular thrombolytic safety and EVD tract hemorrhage. Springer Science+Business Media, LLC, 2012 Intracerebral hemorrhage nationallicence Intraventricular hemorrhage nationallicence Cerebrovascular disease nationallicence Stroke nationallicence Critical care nationallicence Jackson Daniel Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA aut Patel Alden Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA aut Darracott Robert Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA aut Hanel Ricardo Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA aut Freeman William Departments of Neurology and Critical Care, Mayo Clinic, 4500 San Pablo Road, 32224, Jacksonville, FL, USA aut Hanley Daniel Departments of Neurology, Neurosurgery, and Anesthesiology & Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA aut Neurocritical Care Springer US; http://www.springer-ny.com 19/1(2013-08-01), 103-110 1541-6933 19:1<103 2013 19 12028 https://doi.org/10.1007/s12028-012-9713-1 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-012-9713-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Jackson Daniel Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA aut NATIONALLICENCE 700 1- Patel Alden Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA aut NATIONALLICENCE 700 1- Darracott Robert Department of Pharmacy, Mayo Clinic, Jacksonville, FL, USA aut NATIONALLICENCE 700 1- Hanel Ricardo Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA aut NATIONALLICENCE 700 1- Freeman William Departments of Neurology and Critical Care, Mayo Clinic, 4500 San Pablo Road, 32224, Jacksonville, FL, USA aut NATIONALLICENCE 700 1- Hanley Daniel Departments of Neurology, Neurosurgery, and Anesthesiology & Critical Care Medicine, The Johns Hopkins University, Baltimore, MD, USA aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/1(2013-08-01), 103-110 1541-6933 19:1<103 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer