Intraventricular Hemorrhage (IVH)

An intraventricular hemorrhage is bleeding within your brain’s ventricles. Ventricles are fluid-filled spaces inside your brain. These spaces normally hold cerebrospinal fluid (CSF). CSF cushions and protects your brain. When bleeding happens, blood mixes with the CSF and can block its normal flow. This may cause your ventricles to enlarge, which puts pressure on your brain.

It can also affect preterm newborns since their blood vessels are particularly fragile. In adults, it often happens after a stroke, aneurysm rupture or another brain injury.

Bleeding in or around your brain is a medical emergency. You’ll need immediate medical care to treat this condition and prevent life-threatening complications.

Types of intraventricular hemorrhage

There are two types of IVH:

• Primary: The bleeding starts within your ventricles. This is most common in preterm babies. It can also happen in adults and is often linked to a nearby blood vessel abnormality/malformation.
• Secondary: The bleeding starts somewhere else in your brain and spreads into your ventricles.

Intraventricular hemorrhage symptoms

Symptoms vary based on age. Your newborn won’t be able to tell you what they’re feeling. Look for signs like:

• A bulging soft spot (fontanelle) on their head
• Pale, gray or blue skin color
• Pauses in breathing (apnea)
• Seizures
• Slow heart rate (bradycardia)
• Unusual sleepiness
• Weak muscle tone

In older children and adults, symptoms usually appear suddenly and may include:

• Severe headache
• Confusion
• Nausea and vomiting
• Seizures
• Weakness or numbness
• Sudden loss of consciousness

Intraventricular hemorrhage causes

There are different causes based on the age at which IVH happens:

• Preterm infants: Fragile blood vessels in the germinal matrix (a region in a baby’s growing brain where blood vessels are still developing) cause this condition. Because preterm babies can’t regulate blood flow and blood pressure as well, even small swings in oxygen or circulation can trigger bleeding.
• Older children and adults: Bleeding from an abnormal vessel (for example, a brain aneurysm or arteriovenous malformation) or another brain problem causes IVH. High blood pressure can cause bleeding in brain tissue, which can then spread into your ventricles. Head injuries, blood thinners and stroke could cause bleeding, too.

Who is at risk for IVH?

Babies have a higher risk if they’re born before 32 weeks or weigh less than 3.3 pounds (about 1,500 grams). Other risks for babies include:

• Air leak in their lungs (pneumothorax)
• Fluctuating blood pressure or clotting problems
• Needing mechanical ventilation
• Respiratory distress
• Sepsis or another severe infection

Risk factors for adults include:

• Chronic high blood pressure
• Severe head trauma
• Stroke
• Use of blood thinners (anticoagulants)
• Vascular abnormalities, like AVMs or aneurysms

Complications of intraventricular hemorrhage

Complications of IVH may be life-threatening. In infants, these can include:

• Damage to brain tissue (periventricular leukomalacia)
• Enlarged brain spaces after bleeding (posthemorrhagic ventricular dilatation)
• Fluid buildup in their brain (hydrocephalus)
• Seizures
• Stroke-like brain injury from bleeding (periventricular hemorrhagic infarction)

Other complications aren’t usually life-threatening for children but can affect long-term development. These include:

• Cerebral palsy
• Developmental delays
• Intellectual disabilities

In older children and adults, complications may include:

• Another stroke
• Brain or nerve problems like weakness, trouble speaking, memory loss or loss of thinking skills
• Coma or decreased alertness
• Fluid buildup in the brain that adds extra pressure on nearby areas (hydrocephalus with increased intracranial pressure)
• Seizures

How doctors diagnose intraventricular hemorrhage

Imaging tests are the main way to diagnose IVH. In newborns, routine head ultrasounds commonly screen for IVH.

In older children and adults, providers usually order a CT scan or an MRI. These tests create clear pictures of your brain’s ventricles so providers can find the bleeding.

Intraventricular hemorrhage stages

Providers stage or grade an IVH in preterm infants from I to IV based on how much bleeding there is. All need immediate medical care, but grades III and IV are the most severe:

• Grade I: Bleeding is in a small area near the ventricles (germinal matrix).
• Grade II: Bleeding is inside the ventricles, but they don’t enlarge.
• Grade III: Bleeding fills the ventricles and makes them enlarge (ventricular dilatation).
• Grade IV: Bleeding spreads into brain tissue around the ventricles (intraparenchymal hemorrhage).

Intraventricular hemorrhage treatment

Treatment depends on age. It focuses on preventing complications and lowering pressure in your brain.

For newborns, care is mainly supportive. Providers may keep your baby’s head slightly raised and limit sudden movements. They’ll also closely manage blood pressure and oxygen levels to protect their fragile blood vessels. There isn’t a medicine that can stop bleeding once it starts, but supportive care helps prevent further damage.

For children and adults, treatment focuses on clearing the blood from the ventricle and managing fluid buildup (hydrocephalus). Your care team may:

• Stabilize your blood pressure
• Repair an aneurysm or AVM
• Place a temporary device to drain CSF/blood and relieve pressure (external ventricular drain or a ventricular reservoir)

If hydrocephalus is long-term, providers may place a permanent shunt to move fluid from your brain to your abdomen.

What is the recovery time?

Healing from an IVH doesn’t happen overnight. It can take several weeks for your body to absorb the blood. A healthcare provider will let you and your loved ones know what to expect since everyone’s situation is different.

When should I see my healthcare provider?

IVH is a very serious medical condition. Visit the emergency room right away if you notice symptoms like:

• A severe headache
• Confusion
• Neck stiffness
• Seizures
• Stroke-like symptoms (weakness, vision changes, etc.)

What is the prognosis for intraventricular hemorrhage?

The outlook depends on how severe the bleeding is, your age and overall health.

Mild bleeds (grades I and II) usually have a good outcome with close care. Many children and adults recover without lasting problems, though there’s still a small risk of complications.

Severe bleeds (grades III and IV) are more serious and can be life-threatening if not treated quickly. Long-term problems are more common.

Because every person’s situation is different, a healthcare provider is the best source of information about your prognosis.

Can intraventricular hemorrhage be prevented?

Not all cases can be prevented. But you can take steps to lower your risk.

During pregnancy, you should work closely with your prenatal care team. Good prenatal care helps reduce the risk of preterm birth. This is the biggest risk factor for IVH in babies. If preterm birth looks likely, your provider may give you medicines that can lower the chance of severe IVH in your baby.

Adults can lower their risk by:

• Avoiding smoking and limiting alcohol use
• Managing high blood pressure
• Treating underlying causes like a brain aneurysm or arteriovenous malformation