脳血管障害による脳室内出血症例の臨床的検討 : 脳室内出血の重症度評価と転帰について

Intraventricular hemorrhage (IVH) may occur primarily, but often secondarily to known cerebrovascular diseases such as hypertensive brain hemorrhage, moyamoya disease, arteriovenous malformation (AVM), ruptured cerebral aneurysm and so on. The severity of the original disease with IVH has been evaluated according to the grading of severity, indication for surgery and/or the results of treatment. However, there is no established evaluation scale for IVH itself regardless the original disease. The purpose of this study was to estimate the neurological impacts of IVH on the patient with a novel grading system for IVH.
Two hundred and thirty seven cases with IVH were treated in our service between April 1987 and March 1993 ; of which 182 IVHs were following hypertensive brain hemorrhages (thalamic hemorrhage : 105, putaminal hemorrhage : 61, caudate hemorrhage : 9 and subcortical hemorrhage : 7), 19 IVHs following moyamoya disease, 16 IVHs following AVM and 20 IVHs following ruptured cerebral aneurysm.
Patients with cast formation following thalamic hemorrhage and moyamoya disease had a statistically higher frequency (p<0.05) of consciousness disturbance and patients with thalamic hemorrhage and putaminal hemorrhage (under 70 years old) demonstrated poorer outcome than patients without cast formation (p<0.05). Severe intraventricular hemorrhage with cast formation was thought to be an important factor for the neurological symptoms and outcome of patients with thalamic hemorrhage, moyamoya disease and putaminal hemorrhage.
In the present study, a grading system for IVH was applied to evaluate patients using a combination of lateral ventricle score and third-fourth ventricle score. Patients with IVH were divided into 3 groups according to the grading system. The severe (SE) group comprised 58 patients with a greater severity of the score ; the moderate (MO) group comprised 80 patients with an intermediate level of severity of the score and the mild (ML) group comprised 99 patients with a lower severity of the score. It was found that 37 of 58 patients (63.8%) in the SE group, 36 of 80 patients (45.0%) in the MO group and 19 of 99 patients (19.2%) in the ML group had poor outcome. The rate of poor outcomes increased in accordance with the degree of severity in the grading system (p<0.01).
Surgical treatment for IVH has routinely used with ventricular drainage (VD). Patients with VD demonstrated better outcome than patients without VD in the SE group (p<0.05). However, outcomes for the MO and the ML groups showed no significant differences between with and without VD.
It is concluded that the severity of IVH is one of important factor in neurolgical outcome, therefore, it should be considered as one of additional factor to the severity of the original disease. The grading system for IVH proposed in this study is considered to provide a useful clinical evaluation scale for such patients.