GAMBARAN OUTCOME PASIEN INTRAVENTRICULAR HEMORRHAGE (IVH)

YANG DILAKUKAN TINDAKAN OPERASI DAN PEMBERIAN NIMODIPIN

DI RSUD Dr. ZAINOEL ABIDIN BANDA ACEH

Syahrul1, Laila Fajri2, Ellya Nurfida2, Khatab2, Nurul Fajri2 , Nona Suci. R2, Rita Mulyana2

1
Staff of Neurology, FK Unsyiah / RSUD Dr. Zainoel Abidin Banda Aceh
2
Resident of Neurology, FK Unsyiah / RSUD Dr. Zainoel Abidin Banda Aceh

ABSTRACT

Introduction

Brain hemorrhage has the highest morbidity of any stroke subtype. Intraventricular hemorrhage
(IVH) has a particularly poor prognosis with the expected mortality between 50% and 80%. The
incidence of hydrocephalus in IVH patients could increase the mortality and intubation rates.
Although the resolution of hydrocephalus occurs in 96% of patients, the outcome predominantly
depends on preoperative GCS score; 81% have a good recovery with a GCS score ≥ 9 and 56%
mortality risk in patients with initial GCS score of ≤ 8. In patients with IVH, a more favorable
outcome result from early surgical intervention compared to conservative management, 18% and
12% respectively. IVH-related vasospasm is another possible complication in IVH patients.
Early detection with a proper treatment could improve clinical outcomes in such cases.

Methods
We use a retrospective cross-sectional study design. We collect data from patients admitted in
our hospital from July 2018 to September 2018 that was diagnosed and treated for IVH. The
clinical information, treatment, and prognosis at follow-up were also analyzed.

Results
We collected 20 cases of Intraventricular Hemorrhage (IVH), that consist of 12 male (60%) and
8 females (40%) with an average age of 50 years. Patients characteristics were as follows; for the
major complaints, 75% (15 patients) have a decrease in consciousness level, 15% (3 patients)
have a headache, and 10% (2 patients) have limb weakness; other complaints are hypertension
encephalopathy (60%) and hypotension (5%). GCS scores found during the examination; 13
patients presented with GCS scores ≥ 9 and 7 patients with score ≤ 8. Radiology findings were;
15 patients with ICH, IVH, and SAH, and 5 patients with findings of only IVH. Therapy for
patients; 8 patients undergo surgical treatment for VP shunt and their postoperative management
were followed-up, and 12 patients refused to have surgery were given a continuous treatment of
nimodipine. 6 patients that went for VP shunt died following the surgery, and 2 were discharged
for home care. The first patients died one-day post-surgery. This patient presented with GCS
Score 8, hypertensive encephalopathy, brain imaging of ICH, IVH and with complications of
hepatitis sepsis and DIC. 5 other patients died after the 7th treatment due to complications of
sepsis. 2 patients that were discharged, presented with GCS score ≥ 10.
12 patients that were treated with continuous nimodipine were given the drugs on a drip for 10
days and then switch to oral therapy. 6 of these patients were discharged with GCS score ≥ 12,
and an improvement on both clinical and Brain Imaging. The remaining 6 patients died, 2
patients died within 2 days of treatment, they were presented with GCS score ≤ 8, hypertension
encephalopathy, head Ct scan ICH, SAH, IVH, and sepsis. 4 patients died after the 10th day of
treatment with GCS score ≤ 11 and complications of sepsis.

Conclusion
We reported 20 cases of IVH, and we compared patients who underwent surgery and non-
surgical therapy with nimodipine. Patients outcome depended on the clinical condition when the
patient arrived in the hospital, GCS score, brain imaging and complications during treatment.

Key Words

intraventricular hemorrhage (IVH), outcome, surgical therapy, nimodipin, CT-Scan