Causes and Diagnosis of Intraventricular Hemorrhage

Primary Classification and Etiologies

Intraventricular hemorrhage in adults is most commonly secondary to hypertensive intracerebral hemorrhage involving the basal ganglia and thalamus, occurring in approximately 45% of patients with spontaneous ICH, according to the American Heart Association 1, 2
The American College of Radiology recommends categorizing IVH into two main types: secondary IVH, which originates as an extension from an intracerebral hemorrhage, and primary IVH, which is confined to the ventricles without associated intraparenchymal hemorrhage 2

Hypertensive hemorrhage is the most common underlying etiology, typically presenting as deep hemorrhages in the basal ganglia, thalamus, pons, or cerebellum that extend into the ventricular system, as reported by the Journal of the American College of Radiology 4
Vascular malformations, including arteriovenous malformations, dural arteriovenous fistulas, and cavernous malformations, can cause IVH, according to the American College of Radiology 4, 5
Cerebrovascular conditions, such as cerebral amyloid angiopathy, cerebral venous thrombosis, and moyamoya disease, can also contribute to IVH, as stated by the American College of Radiology 4, 5
Coagulopathy-related causes, including anticoagulant use and antiplatelet agents, can increase the risk of IVH, as noted by the American College of Radiology 5, 6

The presence of IVH dramatically worsens prognosis, with mortality increasing from 20% in ICH without IVH to 51% in ICH with IVH, according to the American Heart Association 1, 2
The American College of Radiology recommends additional workup, including cerebral angiography and MRI/MRA, when the underlying cause of IVH is not immediately apparent from history and initial imaging 5
Coagulation studies are also recommended to identify potential coagulopathy-related causes of IVH, as stated by the American College of Radiology 6