İntraventriküler kanama

Özet

Kafa travması, intraparenkimal kanama veya damar kaynaklı kanama sonrası bilinç değişikliği olan hastada ventrikül içi kan aranır. Kontrastsız beyin BT'si akut kanı hızlıca gösterir ve kanın hangi ventriküllere yayıldığını, BOS yollarını tıkayıp tıkamadığını ortaya koyar. Üçüncü ya da dördüncü ventrikülün pıhtıyla dolması ve ventriküllerin genişlemesi akut obstrüktif hidrosefaliyi düşündürür. Kanın kaynağı ve hidrosefali atlanırsa hızla kötüleşen kafa içi basınç artışı gözden kaçabilir.

Faz ve pencere

Kontrastsız tanısal

Akut intraventriküler kan, özellikle üçüncü ve dördüncü ventrikülleri doldurarak döküm benzeri (casting) bir görünüm oluşturabilir ve bu durum akut hidrosefaliye yol açabilir. Kan, foramen Monro, sylvius akuaduktü veya dördüncü ventrikül çıkışlarını tıkayarak obstrüktif hidrosefaliye neden olabilir; nonkontrast BT'de ventriküllerdeki kan pıhtıları ve hidrosefali izlenir.

BT bulguları

• İntraventriküler kan, lateral ventriküllerin gövdelerinde, oksipital boynuzlarında veya üçüncü ve dördüncü ventriküllerde yaygın olarak izlenebilir ve ventrikülleri doldurarak döküm benzeri bir görünüm verebilir.
• İntraventriküler kan, ventrikül boşluğunu kalıp gibi dolduran pıhtı görünümü oluşturabilir ve BOS akımını tıkayarak obstrüktif hidrosefaliye yol açabilir.
• Ventrikül genişlemesi — kanla dolu bölmenin beklenenden geniş olması, temporal boynuzların belirginleşmesi ve periventriküler transependimal BOS geçişi.
• Eşlik eden parankimal kaynak — talamus, bazal gangliyon, kaudat başı veya lobar hematomdan ventriküle uzanan devamlılık.
• Travmatik intraventriküler kanama değerlendirilirken eşlik eden diğer travmatik beyin yaralanmaları da BT'de aranmalıdır.
• Subaraknoid kanla iletişim — sisternal veya sulkal kanın ventriküler pıhtıdan ayrı dağılımı; tek başına ventriküler kan görünümü kaynağı belirlemez.
• Parankimal hematomla açıklanamayan spontan IVH'nin nadir bir nedeni, ventrikül içine uzanan anterior kommunikan arter anevrizması olabilir.

Ölçütler ve sınıflamalar

Klasik Graeb skoru

Klasik Graeb skoru 0–12 aralığındadır. Graeb skoru IVH’yi 0–12 aralığında derecelendirir.

Modifiye Graeb skoru (mGS)

Modifiye Graeb skoru, IVH için kullanılan skorlama sistemlerinden biridir.

Normalde

Sağ-sol ventrikül boyutlarını, temporal boynuzları ve üçüncü ventrikül genişliğini aynı kesitte kıyaslayın; yeni genişleme, periventriküler düşük dansite ve çıkış yolundaki pıhtı birlikteyse hidrosefali lehinedir.

Ayırıcı tanı

Koroid pleksus ksantogranülomu, supratentoryal intraventriküler kitlelerin ayırıcı tanısında yer alır.

Ventrikül içi tümör

foramen Monro veya koroid pleksus düzeyinde doku kitlesi, kitle etkisi ve bazen kalsifikasyon yapar; kan gibi bağımlı tabakalaşmaz.

Ventriküle komşu parankimal hematom

kan ventriküle açılmış olabilir; parankim içindeki kaynak hematomun devamlılığını takip edin.

Tuzaklar

• Travmatik intraventriküler kanama değerlendirilirken eşlik eden diğer travmatik beyin yaralanmaları da gözden geçirilmelidir.
• Ventriküler asimetriyi tek başına hidrosefali saymayın; eski incelemeyle karşılaştırıp temporal boynuzlar, üçüncü ventrikül ve periventriküler BOS geçişini birlikte değerlendirin.
• Ventrikül içi kanın görülmesi travmatik ya da spontan kaynağı tek başına kanıtlamaz; eşlik eden parankimal hematom, damar çevresi dağılımı ve travma izlerini arayın.
• Travma sonrası kalıcı ventrikül genişlemesi serebral atrofi olarak yorumlanabilir; bu nedenle hidrosefali olasılığı görüntüleme bulgularıyla birlikte değerlendirilmelidir.

Kendini dene

1. Üçüncü ve dördüncü ventriküllere uzanan kalıp benzeri intraventriküler kanamada hangi komplikasyon bildirilmiştir?

   • Akut hidrosefali
   • Serebral atrofi
   • Normal basınçlı hidrosefali
   • İzole subaraknoid kanama
   Cevabı göster

   Akut hidrosefali. Kalıp benzeri intraventriküler kanama üçüncü ve dördüncü ventriküllere uzanabilir ve akut hidrosefaliyle birlikte görülebilir.

2. Üçüncü ventrikülde kan pıhtısı ve BOS yollarındaki tıkanıklık söz konusu olduğunda, gelişen ventriküler genişlemenin nedeni nedir?

   • BOS akımının engellenmesine bağlı obstrüktif hidrosefali
   • Nöron kaybına bağlı serebral atrofi
   • Yaşa bağlı normal ventrikül büyümesi
   • Parankimal kontüzyona bağlı lokal ödem
   Cevabı göster

   BOS akımının engellenmesine bağlı obstrüktif hidrosefali. Kaynaklar, ventriküler sistemdeki pıhtılaşmış kanın BOS akımını tıkayarak obstrüktif hidrosefaliye neden olduğunu açıklamaktadır.

İlgili konular

• Hemorajik serebral kontüzyon
• Diffüz aksonal yaralanma
• Travmatik beyin sapı yaralanması

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 14 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.