CNS FIBRINOLYSIS - A REVIEW OF THE LITERATURE WITH A PEDIATRIC EMPHASIS

In vitro studies of cerebrospinal fluid indicate that normal cerebrosp inal fluid contains very low levels of fibrinolytic enzymes but that f ibrinolytic activity is higher in pathologic compared with normal cond itions and in older compared with younger patients. Because of the low endogenous fibrinolytic activity of the central nervous system, intra ventricular fibrinolytic therapy has been studied in adult and pediatr ic patients for the treatment of intraventricular hemorrhage/posthemor rhagic hydrocephalus and subarachnoid hemorrhage with secondary cerebr al vasospasm, A review of the literature about endogenous and exogenou s fibrinolysis studies of animals, adult humans, and pediatric humans reveals a record of predominant safety and efficacy, Although its use in the adult population for the treatment of subarachnoid hemorrhage w ith secondary vasospasm has become an accepted therapy in some centers , its use in the pediatric population is less common, It is no longer considered in the treatment of meningitis, but its role in the treatme nt of intraventricular hemorrhage/posthemorrhagic hydrocephalus is sti ll being investigated. (C) 1998 by Elsevier Science Inc. All rights re served.