Abstract
Dear Editor: Brainstem haematoma (BSH) with hydrocephalus is a rare fonn of BSH [I]. Following the publication of the largest documented series of spontaneous BSH [I], we would like to present a particular scenario that was managed differently. A previously fit and well 54-year-old female, with no previous history of hypertension, presented with sudden onset of headache and drowsiness. Her initial Glasgow Coma Scale (GCS) of II dropped further to 8, at which point she was intubated and ventilated. An initial computed tomography (CT) scan was consistent with BSH with radiological evidence of hydrocephalus. An external ventricular drain was inserted and the initial increased intracranial pressure (ICP) was 30 cm of H20. The drain was progressively raised in height and removed. However, she subsequently had four attacks of recurrent drop in GCS and respiratory depression. All these episodes necessitated reinsertion of external ventricular drainage (EVD) or a drop in its height to facilitate drainage of cerebrospinal fluid (CSF). On all four occasions, a raised ICP was noted and the GCS improved following CSF drainage.
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