Transient Hydrocephalus Caused by Primary Intraventricular Hemorrhage

A 66-year-old female was admitted to a nearby hospital with acute altered consciousness following a headache. She had a history of hypertension and dyslipidemia and had been taking candesartan and pitavastatin. Upon admission, the patient exhibited disorientation, restlessness, and elevated blood pressure of 157/93 mmHg. Brain magnetic resonance imaging (MRI) revealed ventriculomegaly in the lateral and third ventricles (Figure 1A) and blood clots in the Sylvian aqueduct and right lateral ventricle (Figure 1B–E) with no tumorous lesions. Brain computed tomography was not performed. After admission, the patient was monitored, and the symptoms spontaneously improved the following day. Brain MRI performed 13 days after onset, upon referral to our hospital, showed resolution of ventricular enlargement and disappearance of the intraventricular clots (Figure 1F–H). Blood examination demonstrated no coagulation abnormalities, and no vascular malformations were detected on cerebral angiography, leading to a diagnosis of primary intraventricular hemorrhage (PIVH). PIVH is an uncommon type of intracerebral hemorrhage, which is localized to the ventricular system and immediate parenchymal ependymal lining [1]. In the ventricular system, the sylvian aqueduct can be easily obstructed, resulting in hydrocephalus, even if the clot is small. Minor hemorrhages, as demonstrated in our case, require careful scrutiny due to their propensity to be easily missed in patients with PIVH [2, 3]. We would like to thank all members of the Department of Neurology, Oita University Hospital, for helping with the collection of clinical data. We would like to thank Editage (www.editage.jp) for English language editing. The authors have nothing to report. The authors have nothing to report. Informed consent was obtained from the patient to publish this article. The authors declare no conflicts of interest. Research data are not shared.