The patient was admitted to the ICU of Shmaisani hospital with massive intraventricular hematoma. The patient was found at home unconscious and brought to the ICU. He is diabetic type I in insulin. CT-scan of the brain showed the hematoma.

On examination: He is unconscious with left sided plegia. He has severe acidosis and clinically was not responding to verbal commands. The pupils still equal and responsive to light. The patient was urgently sent to the MRI and the hematoma was bigger and he was put in ventilator. MRA ruled out presence of aneurysm or AVM, but showed slight spasm of the right M1 segment. The hematoma was fulfilling the right inferior horn denoting that the origin was from the choroid plexus of this area. The hematoma was fulfilling the third and right lateral ventricle and 2/3 of the left lateral ventricle. The hematoma also fulfilled the 4th ventricle with absent CSF at these areas. Considering these data and the rapid deterioration of the patient, he was urgently sent to the operating room.

The bur hole was created over the left anterior horn projection, because there is still CSF there and the right was full of blood. The external drain was inserted 5 cm depth and the CSF came out after what the massive intraventricular hematoma start to come out. The position of the ventral part of the external drain was checked by C-arm and the patient was sent to MRI control, which showed dramatic improvement of the ventricular cavities.

The patient was sent to the ICU to keep him for 48 hours in ventilator and to keep the external drain for 72 hours.

The patient in ventilator with stable vital signs.

The patient is rapidly deteriorating as this surgical step is life saving procedure. The prognosis depends upon several factors.

The cause of the hematoma is still unknown, but there is no arterial aneurysm, nor AVM.