الفهرس 
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Abstract
This prospective clinical trial study was carried out on 25 patients with spontaneous IVH undergoing EVD placement with clinical and radiological follow up for 3 months. It was shown that EVD in the context of obstructive hydrocephalus significantly decreases the mortality compared to conservatory treatment. The aim of this work is to study the role of external ventricular drain in cases of spontaneous intraventricular haemorrhage through assisting clearance of intraventricular blood, controlling of acute obstructive hydrocephalus and monitoring and managing of intracranial pressure. Summary of our results: The age of the patients ranged from 25-76 years with mean value (± SD) 56.2 ± 10.02 years. There were 17 (68%) patients with age ≤ 60 y and eight (32%) patients > 60 y. There were 13 (52%) male patients and 12 (48%) female patients. Most of cases were hypertensive (20 patients; 80%). Diabetes mellitus was found in seven patients (28%), asthma was found in two patients (8%), chronic kidney disease was found in 2 patients (8%), HCV was found in two patients (8%), HCC was found in two patients (8%), coagulopathy was found in two patients (8%) and cardiac disease was found in five patients (20%). Preoperative systolic blood pressure ranged from 120-220 mmHg with mean value (±SD) 170.4 ± 25.57 mmHg and diastolic blood pressure ranged from 70-130 mmHg with mean value (±SD) 99.2 ± 16.05 mmHg. There were eight patients (32%) with 1ry IVH and 17 patients (68%) with 2ry IVH. IVH was found in right lateral ventricle in 20 patients (80%), in left lateral ventricle in 18 patients (72%), in 3rd ventricle in 25 patients (100%), in 4th ventricle in 22 patients (88%) and in all ventricles in 17 patients (68%). Initial Graeb’s score ranged from 3-12 with median value of eight. Intracranial haemorrhage was found in 17 patients (68%) and eight patients (32%) didn’t develop ICH. According to associated ICH, the size ranged from 3-26 cm2 with mean value (±SD) 11.29 ± 7.27 cm2. As regard to the site, five patients (29.4%) have lobar ICH, ten patients (58.8%) have thalamic ICH and two patients (11.2%) have cerebellar ICH. As regard to the side, nine patients (52.9%) were in the right side and eight patients (47.1%) were in the left side. There were 23 patients (92%) presented with disturbed conscious level, four patients (16%) presented with seizures, 14 patients (56%) presented with vomiting, ten patients (40%) presented with weakness and five patients (20%) presented with headache. As regard to GCS, it ranged from 4-13 with median value nine. There were 22 patients (88%) presented with hydrocephalus. Duration till operation ranged from 3-36 hours with median value of five hours. As regard to the side of EVD, 16 patients (64%) were in the right and nine patients (36%) were in the left side. The duration of EVD ranged from 3- 11 days with mean value (± SD) 6.64 ± 2.25 days. Average daily CSF ranged from 50-180 cm with mean value (±SD) 90.4 ± 223.4 cm. Total CSF ranged from 250-1260 cm with mean value (±SD) 583.2 ± 223.4 cm. ICP monitoring was done in eight patients (32%) with Medtronic type. 7th day Graeb’s score ranged from 1-6 with median value three. ICU stay ranged from 2-25 days with median value of seven days and hospital stay ranged from 7-25 days with median value of 11 days. As regards postoperative complications, seven patients (28%) had chest infection, four patients (16%) had pneumocephalus, nine patients (36%) had obstruction, two patients (8%) died at 30 days, four (16%) patients died at three months, five patients (20%) had infection (meningitis) and nine patients (36%) had shunt dependency. GCS at admission ranged from 4-13 with median value nine, 24 hours GCS ranged from 5-11 with median value 11 and 7th day GCS ranged from 5- 15 with median value 14. 24 hours GCS was significantly improved compared to GCS at admission and 7th day GCS was significantly improved compared to 24 hours GCS and GCS at admission (P <0.001). GOS at discharge ranged from 1-5 with median value four while three months GOS ranged from 3-5 with median value five. The comparison between GOS at discharge and three months GOS showed insignificant difference (P = 0.575). Initial Graeb’s score ranged from 3-12 with median value eight while 7th day Graeb’s score ranged from 1-6 with median value three. 7th day Graeb’s score was significantly decreased compared to initial Graeb’s score (P <0.001). There was a significant negative moderate correlation between GCS at 7th day and SBP (r = -0.61, P <0.001). There was a significant negative moderate correlation between GCS at 7th day and DBP (r= -0.56, P <0.001). There was a significant negative moderate correlation between GCS at 7th day and size of ICH (r= -0.41, P <0.001). There was a significant positive strong correlation between GCS at 7th day and GCS at admission (r= 0.71, P <0.001). There was a significant negative moderate correlation between GOS at discharge and SBP (r = -0.51, P <0.001). There was a significant negative moderate correlation between GOS at discharge and DBP (r= -0.50, P <0.001). There was a significant negative moderate correlation between GOS at discharge and size of ICH (r= -0.49, P <0.001). There was a significant positive moderate correlation between GOS at discharge and GCS at admission (r= 0.42, P <0.001)