naa a22 4500 510800122 CHVBK 20180411083351.0 cr unu---uuuuu 180411e20130601xx s 000 0 eng 10.1007/s12028-013-9826-1 doi (NATIONALLICENCE)springer-10.1007/s12028-013-9826-1 No Exacerbation of Perihematomal Edema with Intraventricular Tissue Plasminogen Activator in Patients with Spontaneous Intraventricular Hemorrhage [Elektronische Daten] [Wendy Ziai, Tom Moullaali, Saman Nekoovaght-Tak, Natalie Ullman, Jay Brooks, Timothy Morgan, Daniel Hanley] Introduction: In severe spontaneous intraventricular hemorrhage (IVH), intraventricular (IVR) administration of tissue plasminogen activator (rtPA) clears blood from the ventricles more rapidly than with external ventricular drainage (EVD) alone. However, experimental studies suggest tPA may be neurotoxic in compromised brain tissue and may exacerbate perihematomal edema. Methods: We used computerized volumetrics to assess change in intracerebral hemorrhage (ICH), IVH, ventricular, and perihematomal edema (PHE) volumes at 2-4 (T1) and 5-9 (T2) days following diagnostic CT scans (T0) of 24 patients (12 tPA-treated; 12 controls) with IVH requiring EVD. Controls from a hospital registry were matched by IVH and ICH volume to tPA-treated patients who came from a multicenter trial involving 52 patients with IVH. Results: There were no significant differences between matched pairs in admission ICH and IVH volumes. IVR tPA resulted in more rapid clearance of IVH as determined by T2-T0 decrease in median IVH volume (tPA: −18.7cc, iqr 14.9; control:−6.9cc, iqr 6.4; P=0.002). Median ratios of PHE to ICH volume were not significantly different in control versus tPA-treated patients at T1 and T2 [control:tPA=0.55:0.56 (T1); P=0.84 and 0.81:0.71 (T2); P=1.00]. Total ventricular volume was significantly larger in the control group at T2 (mean: 57.57±10.32 vs. tPA: 24.80±2.67cc; P=0.01). Bacterial ventriculitis was more frequent in the control group (5 vs. 1 episodes; P=0.06) as was shunt dependence (4 vs. 0 cases; P=0.03). Conclusions: For case matched large IVH with small ICH volume, IVR tPA enhances lysis of intraventricular blood clots and has no significant impact on PHE. Springer Science+Business Media New York, 2013 Intracerebral hemorrhage nationallicence Intraventricular fibrinolysis nationallicence Intraventricular hemorrhage nationallicence Perihemorrhagic edema nationallicence Recombinant tissue-type plasminogen activator nationallicence Computed tomography nationallicence Ziai Wendy Division of Neurosciences Critical Care, Departments of Neurology, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Meyer 8-140, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut Moullaali Tom Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Nekoovaght-Tak Saman Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Ullman Natalie Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Brooks Jay Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Morgan Timothy Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Hanley Daniel Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Neurocritical Care Humana Press Inc 18/3(2013-06-01), 354-361 1541-6933 18:3<354 2013 18 12028 https://doi.org/10.1007/s12028-013-9826-1 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9826-1 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ziai Wendy Division of Neurosciences Critical Care, Departments of Neurology, Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Meyer 8-140, 600 N. Wolfe St., 21287, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Moullaali Tom Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Nekoovaght-Tak Saman Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Ullman Natalie Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Brooks Jay Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Morgan Timothy Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Hanley Daniel Division of Brain Injury Outcomes, Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 773 0- Neurocritical Care Humana Press Inc 18/3(2013-06-01), 354-361 1541-6933 18:3<354 2013 18 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer