Intraventricular recombinant tissue plasminogen activator for treatment of spontaneous intraventricular haemorrhage in pregnancy

Abstract

Spontaneous intracranial haemorrhage during pregnancy, which is usually subarachnoid or intraparenchymal in nature, causes significant maternal and foetal morbidity and mortality. Solitary intraventricular haemorrhage (IVH) in pregnancy has never been previously reported nor has the use of intraventricular fibrinolysis in this situation. A 28-year-old woman presented at 20 weeks' gestation with status epilepticus from spontaneous severe IVH. Angiography and magnetic resonance imaging did not show the presence of a vascular lesion or aneurysm. Thrombolytic treatment with intraventricular injection of recombinant tissue plasminogen activator (rt-PA) was instituted. Although the foetus aborted spontaneously 6 weeks after the haemorrhage and a ventriculo-peritoneal shunt for hydrocephalus was eventually required, the mother recovered to the level of mild disability at 3 months. Intraventricular fibrinolysis with rt-PA seems to be an effective form of treatment for IVH in pregnancy. © 1999 Harcourt Brace & Co. Ltd.