Thrombolytic Therapy for Intraventricular and Intraparenchymal Hemorrhage

  • J. R. Carhuapoma
  • N. J. Naff
  • D. F. Hanley
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 2000)


Approximately 500 000 new strokes occur every year in the United States. Fifteen percent of these patients are diagnosed with intracerebral hemorrhage (ICH) and 6% of them die before reaching a hospital. The overall mortality of ICH patients continues to be high, with 30 to 50% mortality rate within the first 30 days and with only 10% of the surviving patients remaining capable of independent living after 30 days. Similarly, 25 000 cases of non-traumatic subarachnoid hemorrhage (SAH) are diagnosed annually in the United States, with 18 000 of them resulting in death or severe disability. The range of neurologic deficits after SAH extends beyond motor or sensory deficits and includes personality changes, memory dysfunction, and reduced ability to work as demonstrated by Ogden and co-workers [1], adding to the social and economical cost to society.


Thrombolytic Therapy Intracerebral Hemorrhage Intraventricular Hemorrhage External Ventricular Drainage Vasogenic Edema 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Ogden JA, Utley T, Mee EW (1997) Neurological and psychosocial outcome 4 to 7 years after subarachnoid hemorrhage. Neurosurgery 41: 25–34PubMedCrossRefGoogle Scholar
  2. 2.
    Adams HP, Torner JC, Kassell NF (1992) Intraventricular hemorrhage among patients with recently ruptured aneurysms: A report of the cooperative aneurysm study. Stroke 23: 140–145Google Scholar
  3. 3.
    Daverat P, Castel JP, Dartigues JF, Orgogozo JM (1991) Death and functional outcome after spontaneous intracerebral hemorrhage. Stroke 22: 1–6PubMedCrossRefGoogle Scholar
  4. 4.
    Findlay JM, Wong JH (1997) Clinical aspects of intraventricular hemorrhage. In: Welch KMA, Caplan LR, Reis DJ, Siesjo BK, Weir B (eds) Primer on Cerebrovascular Diseases. Academic Press, San Diego, pp 437–446CrossRefGoogle Scholar
  5. 5.
    Mohr JP, Ferguson G, Khan M, et al (1983) Intraventricular hemorrhage from ruptured aneurysm.J Neurosurg 58: 482–487CrossRefGoogle Scholar
  6. 6.
    Bagley C (1928) Blood in the cerebrospinal fluid. Resultant functional and organic alterations in the central nervous system. Arch Surg 17: 39–81CrossRefGoogle Scholar
  7. 7.
    Deland FH, James AE Jr, Ladd DJ, Konigsmark BW (1972) Normal pressure hydrocephalus. A histologic study. Am J Clin Path 58: 58–63Google Scholar
  8. 8.
    Ellington E, Margolis G (1969) Block of arachnoid villi by subarachnoid hemorrhage. J Neurosurg 30: 651–657PubMedCrossRefGoogle Scholar
  9. 9.
    Kibler RF, Couch RSC, Crompton MR (1961) Hydrocephalus in the adult following spontaneous hemorrhage. Brain 84: 45–61PubMedCrossRefGoogle Scholar
  10. 10.
    Grabham PW, Monard D, Gallimore PH, Grand RJA (1991) Modulation of human neurite outgrowth by serine proteases: a comparison of the interaction of thrombin and prothrombin with glia-derived nexin. Eur J Neurosci 3: 663–668PubMedCrossRefGoogle Scholar
  11. 11.
    Jalink K, Moolenaar WH (1992) Thrombin receptor activation causes rapid neural cell rounding and neurite retraction independent of classic second messengers. J Cell Biol 118: 411–419PubMedCrossRefGoogle Scholar
  12. 12.
    Smith-Swintowski VL, Zimmer S, Fenton JW, Mattson MP (1995) Protease nexin-1 and thrombin modulate neuronal Ca homeostasis and sensitivity to glucose deprivation-induced injury. J Neurosci 15: 5840–5850Google Scholar
  13. 13.
    Suidan HS, Stone SR, Hemmings BA, Monard D (1992) Thrombin causes neurite retraction in neuronal cells through activation of cell surface receptors. Neuron 8: 363–375PubMedCrossRefGoogle Scholar
  14. 14.
    Vaughan, PJ, Pike CJ, Cotman CW, Cunningham DD (1995) Thrombin receptor activation protects neurons and astrocytes from cell death produced by environmental insults. J Neurosci 15: 5389–5401PubMedGoogle Scholar
  15. 15.
    Zurn, AD, Nick H, Monard D (1998) A glia-derived nexin promotes neurite overgrowth in cultured chick sympathetic neurons. Dev Neurosci 10: 17–24CrossRefGoogle Scholar
  16. 16.
    Gurwitz D, Cunningham DD (1988) Thrombin modulates and reverses neuroblastoma neurite overgrowth. Proc Natl Acad Sci USA 85: 3440–3444PubMedCrossRefGoogle Scholar
  17. 17.
    WeinsteinR Gold S CunninghamDD, Gall CM (1995) Cellular localization of thrombin rece 1~ 1> g () - PGoogle Scholar
  18. for mRNA in rat brain: expression by mesencephalic dopaminergic neurons and codistribution with prothrombin mRNA. J Neurosci 15:2906–2919Google Scholar
  19. 18.
    Vu TKH, Hung DT, Wheaton VI, Coughlin SR (1991) Molecular cloning of a functional thrombin receptor reveals a novel proteolytic mechanism of receptor activation. Cell 64: 1057–1068PubMedCrossRefGoogle Scholar
  20. 19.
    Nishino A, Susuki M, Motohashi O, Umezawa K, Nagura H, Yoshimoto T (1993) Thrombin may contribute to the pathophysiology of central nervous system injury. J Neurotrauma 10: 167–179PubMedCrossRefGoogle Scholar
  21. 20.
    Nishino A, Suzuki M, Yoshimoto T, Otani H, Nagura H (1994) A novel aspect of thrombin in the tissue reaction following central nervous system injury. Acta Neurochir 60: 86–88Google Scholar
  22. 21.
    Lee KR, Betz AL, Kim S, Keep RF, Hoff JT (1996) The role of the coagulation cascade in brain edema formation after intracerebral hemorrhage. Acta Neurochir 138: 396–401PubMedCrossRefGoogle Scholar
  23. 22.
    Lee KR, Colon GP, Betz AL, Keep RF, Kim S, Hoff JT (1996) Edema from intracerebral hemorrhage: the role of thrombin. J Neurosurg 84: 91–96PubMedCrossRefGoogle Scholar
  24. 23.
    Lee KR, Kawai N, Kim S, Sagher 0, Hoff JT (1997) Mechanisms of edema formation after intra-cerebral hemorrhage: effects of thrombin on cerebral blood flow, blood-brain barrier permeability, and cell survival in a rat model. J Neurosurg 86: 272–278PubMedCrossRefGoogle Scholar
  25. 24.
    Lee KR, Lorris Betz A, Keep RF, Chenevert TL, Kim S, Hoff JT (1995) Intracerebral infusion of thrombin as a cause of brain edema. J Neurosurg 83: 1045–1050PubMedCrossRefGoogle Scholar
  26. 25.
    Yang GY, Betz AL, Chenevert TL, Brunberg JA, Hoff JT (1994) Experimental intracerebral hemorrhage: relationship between brain edema, blood flow, and blood-brain barrier permeability in rats. J Neurosurg 81: 93–102PubMedCrossRefGoogle Scholar
  27. 26.
    Yang GY, Betz AL, Hoff JT (1994) The effects of blood or plasma clot on brain edema in the rat with intracerebral hemorrhage. Acta Neurochir 60: 555–557Google Scholar
  28. 27.
    Pang D, Sclabassi RJ, Horton JA (1986) Lysis of intraventricular blood clot with urokinase in a canine model: Part 2. In vivo safety study of intraventricular urokinase. Neurosurgery 19: 547–552Google Scholar
  29. 28.
    Schaefer PW, Buonanno FS, Gonzales RG, Schwamm LH (1997) Diffusion-weighted imaging discriminates between cytotoxic and vasogenic edema in a patient with eclampsia. Stroke 28: 1082–1085PubMedCrossRefGoogle Scholar
  30. 29.
    Ay H, Buonanno FS, Schaefer PW, et al (1998) Posterior leukoencephalopathy without severe hypertension. Utility of diffusion-weighted MRI. Neurology 51: 1369–1376Google Scholar
  31. 30.
    Zazulia AR, Diringer MN, Derdeyn CP, Powers WJ (1999) Progression of mass effect after intra-cerebral hemorrhage. Stroke 30: 1167–1173PubMedCrossRefGoogle Scholar
  32. 31.
    Hankey GJ, Hon C (1997) Surgery for primary intracerebral hemorrhage: is it safe and effective? A systematic review of case series and randomized trials. Stroke 28: 2126–2132PubMedCrossRefGoogle Scholar
  33. 32.
    Morgenstern LB, Frankowski RF, Shedden P, Pasteur W, Grotta JC (1998) Surgical treatment for intracerebral hemorrhage (STICH). A single-center, randomized clinical trial. Neurology 51: 1359–1363Google Scholar
  34. 33.
    Schwartz S, Jauss M, Dorfler A, Albert F, Hacke W (1998) Hematoma evacuation does not improve outcome in spontaneous supratentorial intracerebral hemorrhage: A case control study. Acta Neurochir 139: 897–904Google Scholar
  35. 34.
    Hondo H (1983) CT guided stereotactic evacuation of hypertensive intracerebral hematomas. Tokushima J Exp Med 30: 25–39PubMedGoogle Scholar
  36. 35.
    Andrefski JC, Frank JI, Barnett GH, Mirabelli JL, Sila CA, Miller DW (1998) Stereotactic thrombolytic intracerebral hemorrhage evacuation in the neurointensive care unit. Neurology 50: A339 (Abst)Google Scholar
  37. 36.
    Adams RE, Diringer MN (1998) Response to external ventricular drainage in spontaneous intra-cerebral hemorrhage with hydrocephalus. Neurology 50: 519–523PubMedCrossRefGoogle Scholar
  38. 37.
    Aucoin PJ, Kotilainen HR, Gantz NM, Davidson R, Kellogg P, Stone B (1986) Intracranial pressure monitors: Epidemiologic study of risk factors and infection. Am J Med 80: 369–376Google Scholar
  39. 38.
    Rosner MJ, Becker DP (1976) ICP monitoring: Complications and associated factors. Clin Neurosurg 23: 494–519Google Scholar
  40. 39.
    Kanter RK, Weiner LB, Patti M, Robson LK (1985) Infectious complications and duration of intracranial pressure monitoring. Crit Care Med 13: 837–839PubMedCrossRefGoogle Scholar
  41. 40.
    Mayhall CG, Archer NH, Lamb VA, et al (1984) Ventriculostomy-related infections: A prospective epidemiologic study. N Engl J Med 310: 553–559Google Scholar
  42. 41.
    Schultz M, Moore K, Foote AW (1993) Bacterial ventriculitis and duration of ventriculostomy catheter insertion. J Neurosci Nurs 25: 158–164PubMedCrossRefGoogle Scholar
  43. 42.
    Ahmann PA, Lazzarra A, Dykes FD, Brann AW Jr, Schwartz JF (1980) Intraventricular hemorrhage in the high risk preterm infant: Incidence and outcome. Ann Neurol 7: 118–124Google Scholar
  44. 43.
    Akdemir H, Selcuklu A, Pasaoglu A, Oktem IS, Kavuncu I (1995) Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase. Neurosurg Rev 18: 95–100PubMedCrossRefGoogle Scholar
  45. 44.
    Findlay JM, Grace MG, Weir B (1993) Treatment of intraventricular hemorrhage with tissue plasminogen activator. Neurosurgery 32: 941–947PubMedCrossRefGoogle Scholar
  46. 45.
    Findlay JM, Weir B, Stollery DE (1991) Lysis of intraventricular hematoma with tissue plasminogen activator. Case report. J Neurosurg 74: 803–807Google Scholar
  47. 46.
    Shen PH, Matsuoka Y, Kawajiri K, et al (1990) Treatment of intraventricular hemorrhage using urokinase. Neurol Med Chir (Tokyo) 30: 329–333CrossRefGoogle Scholar
  48. 47.
    Todo T, Usui M, Takakura K (1991) Treatment of severe intraventricular hemorrhage by intra-ventricular infusion of urokinase. J Neurosurg 74: 81–86PubMedCrossRefGoogle Scholar
  49. 48.
    Adams HP, Brott TG, Furlan AJ, et al (1996) Guidelines for thrombolytic therapy for acute stroke: A supplement to the guidelines for the management of patients with ischemic stroke. A statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Circulation 94: 1167–1174Google Scholar
  50. 49.
    Coplin WR,Vinas FC, Agris JM, et al (1997) A cohort study of the safety and efficacy of intraventricular urokinase for non-aneurysmal spontaneous intraventricular hemorrhage. Neurosurgery 41: 741 (Abst)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • J. R. Carhuapoma
  • N. J. Naff
  • D. F. Hanley

There are no affiliations available

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