Hypertensive Intraventricular Hemorrhage in a Chinese Population: Clinical Characteristics, Treatment, and Outcomes.

OBJECTIVE

Intraventricular hemorrhage (IVH) is associated with high mortality and poor outcomes in survivors. This study described the clinical characteristics and treatment outcomes of patients with hypertensive IVH (HIVH) in a large single-center Chinese cohort.

METHODS

We conducted retrospective analysis of prospectively maintained stroke registry at a tertiary medical center in China from September 2018 to January 2026. Patients with hypertensive IVH were included, while those with vascular-structural lesions or trauma were excluded. Demographic data, clinical treatments, and outcomes were analyzed.

RESULTS

In total, 489 patients with HIVH were enrolled, including 49 (9.9%) with primary IVH (pIVH) and 440(90%) with secondary IVH (sIVH). Panventricular hemorrhage was the most common overall HIVH pattern (31%), and 170 patients (35%) received external ventricular drainage (EVD). The overall 30-day mortality rate was 26%, and the 90-day mortality rate was 29%, respectively. Multivariate analysis showed that larger hematoma volume (OR=1.02, p=0.001), lower admission GCS score (OR=1.37, p<0.001), and older age (OR=1.03, p=0.011) were independent risk factors for 90-day mortality in patients with HIVH. Subgroup analysis showed that the EVD group had significantly lower 90-day cumulative mortality risk than the non-EVD group (HR=0.57, 95%CI 0.41-0.79, p<0.001), but no significant difference in favorable functional outcome at 90 days [modified Rankin Scale (mRS) 0-2: 22% vs 27%, p=0.265]. Additionally, the EVD group had significantly prolonged hospital stay (21 days vs 13 days, p<0.001). Furthermore, there was no significant difference in 90-day mortality risk between pIVH and sIVH (HR=0.94, 95%CI 0.51-1.75, p=0.848), but pIVH had significantly higher favorable functional outcome rates (mRS 0-2: 65% vs. 21%, p < 0.001).

CONCLUSION

Parenchymal brain injury was the predominant factor associated with prognosis in patients with HIVH. EVD was associated with lower mortality but did not improve functional outcomes.