Document Detail

Exacerbation of perihematomal edema and sterile meningitis with intraventricular administration of tissue plasminogen activator in patients with intracerebral hemorrhage.
MedLine Citation:
PMID:  20305489     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Intraventricular hemorrhage (IVH) is associated with a poor outcome. External ventricular drainage together with clot lysis through intrathecal tissue plasminogen activator (IT-tPA) has been proposed as a promising therapy. However, recent experimental work has implicated tissue plasminogen activator (tPA) in the pathogenesis of cerebral edema.
METHODS: We reviewed the records of all patients with IVH caused by primary supratentorial intracerebral hemorrhage who underwent external ventricular drainage without surgical evacuation between January 2001 and June 2008. Of these 30 patients, we identified 13 who received IT-tPA. The remaining 17 patients served as controls. Hemorrhage, edema volume, and IVH score were determined on admission and by follow-up computed tomographic scans for 96 hours after admission. Discharge outcome was evaluated using the modified Rankin Scale.
RESULTS: There were no significant differences between the treatment and controls in terms of age, Glasgow Coma Scale score, Graeb and LeRoux IVH scores, or intracerebral hemorrhage volume on admission. IT-tPA resulted in more rapid clearance of IVH as determined by the 96-hour decrease in both the Graeb IVH score (tPA, 3.00 +/- .55; control, 1.00 +/- 0.57; P = .05) and the LeRoux IVH score (tPA, 6.2 +/- 0.80; control, 2.25 +/- 1.32; P = .05). Patients treated with IT-tPA demonstrated significantly larger peak ratios of edema to intracerebral hemorrhage volume (1.24 +/- 0.14 vs 0.70 +/- 0.08 in controls; P = .002). Additionally, increased rates of sterile meningitis (46% vs 12%; P = .049) and a trend toward shunt dependence (38% vs 6%; P = .06) were observed in the tPA cohort. Nevertheless, no significant differences in outcome at discharge or length of hospital stay were observed between cohorts.
CONCLUSION: Although IT-tPA hastens the resolution of IVH, it may worsen perihematomal edema formation. Larger prospective studies are required to confirm these findings and to determine whether outcome is adversely affected by IT-tPA administration.
Andrew F Ducruet; Zachary L Hickman; Brad E Zacharia; Bartosz T Grobelny; Reshma Narula; Kuang-Hua Guo; Jan Claassen; Kiwon Lee; Neeraj Badjatia; Stephan A Mayer; E Sander Connolly
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  66     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-22     Completed Date:  2010-06-22     Revised Date:  2010-12-28    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  648-55     Citation Subset:  IM    
Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
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MeSH Terms
Brain Edema / etiology*
Cerebral Hemorrhage / drug therapy*
Fibrinolytic Agents / administration & dosage*
Injections, Intraventricular / adverse effects*,  methods
Magnetic Resonance Imaging / methods
Meningitis / etiology*
Middle Aged
Retrospective Studies
Time Factors
Tissue Plasminogen Activator / administration & dosage*
Tomography, X-Ray Computed / methods
Treatment Outcome
Reg. No./Substance:
0/Fibrinolytic Agents; EC Plasminogen Activator
Comment In:
Neurosurgery. 2011 Jan;68(1):E288-9; author reply E289   [PMID:  21150745 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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