Recombinant tissue plasminogen activator in the treatment of intraventricular hemorrhage secondary to periventricular arteriovenous malformation before surgery

Case report

Krishna Kumar, Denny D. Demeria, Ashok Verma, R. Loch Macdonald, Issam A. Awad, Robert Harbaugh, E. Sander Connolly, Sean D. Lavine

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE AND IMPORTANCE: Intraventricular hemorrhage (IVH) is known to cause acute obstructive hydrocephalus, refractory elevated intracranial pressures (ICPs), and lowered cerebral perfusion pressures, leading to cortical ischemia. Frequent obstruction of external ventricular drains as a result of thrombus is a recurring theme. We present a case of IVH secondary to periventricular arteriovenous malformation (AVM) that was not visible at admission angiography and was treated by intraventricular infusion of recombinant tissue plasminogen activator before surgical intervention. CLINICAL PRESENTATION: An 11-year-old boy presented with acute onset of headache followed by two seizures, loss of consciousness, decerebration, right temporal hematoma, IVH, and acute obstructive hydrocephalus. INTERVENTION: A right external ventricular drain was placed but functioned poorly. ICP could not be controlled by conventional methods. Five milligrams of recombinant tissue plasminogen activator was injected into the ventricular system via the external ventricular drain. This was repeated daily for 4 days. This treatment resulted in progressive improvement in ICP and clinical status. Once the clot partially cleared, magnetic resonance imaging and magnetic resonance angiography suggested the presence of a right periventricular arteriovenous malformation, which was confirmed by angiography and subsequently resected. CONCLUSION: Recombinant tissue plasminogen activator is effective in resolving IVH causing obstructive hydrocephalus and uncontrollable ICP posing a life-threatening situation, secondary to ruptured arteriovenous malformation, before surgical intervention.

Original languageEnglish (US)
Pages (from-to)964-969
Number of pages6
JournalNeurosurgery
Volume52
Issue number4
DOIs
StatePublished - Apr 1 2003

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Arteriovenous Malformations
Tissue Plasminogen Activator
Intracranial Pressure
Hydrocephalus
Hemorrhage
Cerebrovascular Circulation
Angiography
Intraventricular Infusions
Intracranial Hypertension
Unconsciousness
Magnetic Resonance Angiography
Therapeutics
Hematoma
Headache
Seizures
Thrombosis
Ischemia
Magnetic Resonance Imaging

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Kumar, Krishna ; Demeria, Denny D. ; Verma, Ashok ; Macdonald, R. Loch ; Awad, Issam A. ; Harbaugh, Robert ; Connolly, E. Sander ; Lavine, Sean D. / Recombinant tissue plasminogen activator in the treatment of intraventricular hemorrhage secondary to periventricular arteriovenous malformation before surgery : Case report. In: Neurosurgery. 2003 ; Vol. 52, No. 4. pp. 964-969.
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Recombinant tissue plasminogen activator in the treatment of intraventricular hemorrhage secondary to periventricular arteriovenous malformation before surgery : Case report. / Kumar, Krishna; Demeria, Denny D.; Verma, Ashok; Macdonald, R. Loch; Awad, Issam A.; Harbaugh, Robert; Connolly, E. Sander; Lavine, Sean D.

In: Neurosurgery, Vol. 52, No. 4, 01.04.2003, p. 964-969.

Research output: Contribution to journalArticle

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T1 - Recombinant tissue plasminogen activator in the treatment of intraventricular hemorrhage secondary to periventricular arteriovenous malformation before surgery

T2 - Case report

AU - Kumar, Krishna

AU - Demeria, Denny D.

AU - Verma, Ashok

AU - Macdonald, R. Loch

AU - Awad, Issam A.

AU - Harbaugh, Robert

AU - Connolly, E. Sander

AU - Lavine, Sean D.

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Y1 - 2003/4/1

N2 - OBJECTIVE AND IMPORTANCE: Intraventricular hemorrhage (IVH) is known to cause acute obstructive hydrocephalus, refractory elevated intracranial pressures (ICPs), and lowered cerebral perfusion pressures, leading to cortical ischemia. Frequent obstruction of external ventricular drains as a result of thrombus is a recurring theme. We present a case of IVH secondary to periventricular arteriovenous malformation (AVM) that was not visible at admission angiography and was treated by intraventricular infusion of recombinant tissue plasminogen activator before surgical intervention. CLINICAL PRESENTATION: An 11-year-old boy presented with acute onset of headache followed by two seizures, loss of consciousness, decerebration, right temporal hematoma, IVH, and acute obstructive hydrocephalus. INTERVENTION: A right external ventricular drain was placed but functioned poorly. ICP could not be controlled by conventional methods. Five milligrams of recombinant tissue plasminogen activator was injected into the ventricular system via the external ventricular drain. This was repeated daily for 4 days. This treatment resulted in progressive improvement in ICP and clinical status. Once the clot partially cleared, magnetic resonance imaging and magnetic resonance angiography suggested the presence of a right periventricular arteriovenous malformation, which was confirmed by angiography and subsequently resected. CONCLUSION: Recombinant tissue plasminogen activator is effective in resolving IVH causing obstructive hydrocephalus and uncontrollable ICP posing a life-threatening situation, secondary to ruptured arteriovenous malformation, before surgical intervention.

AB - OBJECTIVE AND IMPORTANCE: Intraventricular hemorrhage (IVH) is known to cause acute obstructive hydrocephalus, refractory elevated intracranial pressures (ICPs), and lowered cerebral perfusion pressures, leading to cortical ischemia. Frequent obstruction of external ventricular drains as a result of thrombus is a recurring theme. We present a case of IVH secondary to periventricular arteriovenous malformation (AVM) that was not visible at admission angiography and was treated by intraventricular infusion of recombinant tissue plasminogen activator before surgical intervention. CLINICAL PRESENTATION: An 11-year-old boy presented with acute onset of headache followed by two seizures, loss of consciousness, decerebration, right temporal hematoma, IVH, and acute obstructive hydrocephalus. INTERVENTION: A right external ventricular drain was placed but functioned poorly. ICP could not be controlled by conventional methods. Five milligrams of recombinant tissue plasminogen activator was injected into the ventricular system via the external ventricular drain. This was repeated daily for 4 days. This treatment resulted in progressive improvement in ICP and clinical status. Once the clot partially cleared, magnetic resonance imaging and magnetic resonance angiography suggested the presence of a right periventricular arteriovenous malformation, which was confirmed by angiography and subsequently resected. CONCLUSION: Recombinant tissue plasminogen activator is effective in resolving IVH causing obstructive hydrocephalus and uncontrollable ICP posing a life-threatening situation, secondary to ruptured arteriovenous malformation, before surgical intervention.

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