EFFECT OF RECOMBINANT TISSUE-PLASMINOGEN ACTIVATOR ON CLOT LYSIS AND VENTRICULAR DILATATION IN THE TREATMENT OF SEVERE INTRAVENTRICULAR HEMORRHAGE

Twelve patients with severe intraventricular haemorrhage (IVH) underwe nt intraventricular thrombolysis with recombinant tissue plasminogen a ctivator (rtPA). External ventricular drainage was performed in all pa tients within 24 hours of haemorrhage. Fibrinolytic therapy was starte d within 24 hours from the onset of symptoms in ten cases, and in two further cases after 48 hours and 5 days, respectively. Two to 5 mg of rtPA were injected via the ventricular catheter into one or both later al ventricles. The injection was repeated at intervals ranging from 6 to 24 hours until CT scans demonstrated a substantial reduction of int raventricular blood. The total rtPA doses per patient ranged from 3 to 31 mg. CT scans showed a marked reduction of intraventricular blood a nd normalization of ventricular size within 24 to 48 hours from the be ginning of the fibrinolytic therapy. Rapid reduction of elevated intra cranial pressure by continuous diversion of cerebrospinal fluid could be achieved in all patients, because the ventricular catheters never b ecame obstructed by clotted blood during the fibrinolytic therapy. Dur ing the period of treatment, the level of consciousness, as classified according to the Glasgow Coma Scale, improved from a mean value of 7 to 12. One fatal case of meningitis most probably due to the ventricul ostomy was the only complication related to the treatment. This method of treatment might improve the prognosis in patients in whom a large intraventricular haematoma volume, ventricular dilatation, and impaire d cerebrospinal fluid circulation are major determinants for the outco me.