What is an Intraventricular Hemorrhage?

An intraventricular hemorrhage is a bleeding complication that occurs in one of the four ventricles in the brain. It is a common condition in premature infants due to underdeveloped and weak blood vessels, though an older child or adult can also experience hemorrhaging following major trauma. Once blood starts to leak into a ventricle, it causes painful inflammation and swelling that increase pressure in the skull. Immediate surgical drainage and repair are usually needed to relieve pressure and prevent life-threatening complications.

The ventricles are vital structures that nourish the brain and spinal cord with cerebrospinal fluid (CSF). CSF provides a cushion for the brain to help prevent traumatic injuries. If something happens to ventricular blood vessels that causes them to rupture, the ventricles and surrounding brain tissue inflame and swell. Less space is then available for CSF, and pressure can build to dangerous levels.

Premature infants are at the highest risk of intraventricular hemorrhage because their ventricles and blood vessels are not yet strong enough to perform their functions. In general, cerebral blood vessels remain very fragile until about the 30th week of pregnancy. Among a host of other possible problems, babies who are born before the 30-week mark are likely to have brain hemorrhaging. Head trauma from falls or car accidents can lead to hemorrhaging in adults, as can complications from strokes and surgeries for other brain disorders.

When intraventricular hemorrhage is mild in an infant, the symptoms may include shallow or inconsistent breathing, lethargy, and poor reflexes. Children and adults may also become very lethargic and show signs of extremely painful headaches. Vision, hearing, and speaking abilities may all be compromised, and it is possible to have a seizure or lose consciousness. Intraventricular hemorrhage in a person of any age is a medical emergency.

Doctors in the emergency room first try to stabilize breathing, heart rate, blood loss, and brain functioning with oxygen therapy and medications. If major blood loss has already occurred, an emergency transfusion may be necessary to avoid fatality. Once a patient is stable, specialists can take computerized tomography scans, ultrasounds, and x-rays to look for signs of intraventricular hemorrhage. The hemorrhage is graded based on its size and severity.

If bleeding is well controlled with emergency care and the patient appears to be recovering, surgery may not be needed. Instead, he or she will typically be kept in the hospital for several weeks for monitoring. Anti-inflammatory drugs and blood clotting agents help to relieve swelling and prevent a recurring hemorrhage. A patient does need surgery if pressure in the skull remains high. A shunt can be inserted into the brain to drain excess blood and CSF into the abdomen. Ongoing hospital care, sometimes involving additional surgeries, is often needed for several weeks or months to make sure all symptoms resolve.