What ICH‑Score would a patient receive for an intraventricular hemorrhage measuring 11.7 mm thickness on CT?

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Last updated: September 21, 2026 • View editorial policy

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ICH Score Calculation for IVH Measuring 11.7mm

For an intraventricular hemorrhage measuring 11.7mm thickness on CT, the patient receives 1 point for the IVH component of the ICH Score.

Understanding the ICH Score Components

The ICH Score is a validated 6-point clinical grading scale that predicts 30-day mortality in intracerebral hemorrhage patients 1. The score comprises five components:

  • Glasgow Coma Scale (GCS):

    • GCS 3-4 = 2 points
    • GCS 5-12 = 1 point
    • GCS 13-15 = 0 points

  • Age:

    • ≥80 years = 1 point
    • <80 years = 0 points

  • Infratentorial origin:

    • Yes = 1 point
    • No = 0 points

  • ICH volume:

    • ≥30 cm³ = 1 point
    • <30 cm³ = 0 points

  • Intraventricular hemorrhage (IVH):

    • Present = 1 point
    • Absent = 0 points

The IVH Component Specifically

The presence of ANY intraventricular hemorrhage, regardless of volume or thickness measurement, scores 1 point 1. The original ICH Score uses a binary assessment (present vs. absent) rather than quantifying IVH extent. Your patient's 11.7mm IVH clearly qualifies as "present," contributing 1 point to the total ICH Score.

Clinical Context and Mortality Risk

The complete ICH Score ranges from 0-6 points, with validated mortality predictions 1, 2:

  • Score 0: 0% mortality
  • Score 1: 13% mortality
  • Score 2: 26% mortality
  • Score 3: 72% mortality
  • Score 4: 97% mortality
  • Score 5: 100% mortality

The IVH component alone doesn't determine prognosis—you must calculate all five components to obtain the complete ICH Score 1.

Important Caveats About IVH Assessment

While the original ICH Score treats IVH as binary, recent evidence suggests that IVH topography and extent matter prognostically 3, 4. Specifically:

  • Bilateral lateral ventricular involvement carries nearly 4-fold mortality risk compared to unilateral involvement 4
  • IVH limited to ventricular horns may not increase mortality risk 4
  • The Graeb score (which quantifies IVH volume and distribution) provides additional prognostic information beyond the binary ICH Score assessment 5

Management Implications Based on Guidelines

According to the 2022 AHA/ASA guidelines, patients with moderate to severe IVH (Graeb score ≥7), GCS <13, and ICH volume >11 mL benefit from external ventricular drain (EVD) placement with intraventricular thrombolysis 5. This intervention provides:

  • Class 1 evidence for mortality reduction with EVD plus alteplase/urokinase 5
  • Improved survival compared to EVD alone or conservative management 5
  • No increased risk of symptomatic hemorrhage or ventriculitis 5

Calculate the complete ICH Score using all five components, then integrate with clinical severity markers (GCS, Graeb score) to guide EVD and thrombolytic therapy decisions.

References

2
Research

External validation of the ICH score.

Neurocritical care, 2004

4
Research

Topographic patterns of intraventricular hemorrhage extension and their prognostic significance in intracerebral hemorrhage.

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.