Post-traumatic Hydrocephalus Research Articles

Traumatic Huge Acute Subdural Hematoma of the Posterior Fossa in a Child

Acute subdural hematoma of the posterior fossa is rare, occupying 0.5% to 1.6% of all acute subdural hematomas. In children, it is extremely rare. There has been only 11 cases reported in the literature, excluding neonatal cases. Herein a case was reported of an acute subdural hematoma of the posterior fossa in a child who survived after an emergent surgical exploration. A 6-year-old female was involved in a motor vehicle accident. She fell to the ground, hitting the left occipital region. After a semi-lucid interval several hours, her consciousness deteriorated and she was brought to the hospital. On examination, the patient was comatose, and showed decerebrate posture with bilateral pin-point pupils. Computed tomography scan revealed a huge hematoma which occupied the left posterior fossa and moderate obstructive hydrocephalus. A left suboccipital emergency craniectomy was performed, and an occipital bone fracture was confirmed. Then, subdural hematoma was confirmed, which seemed to be caused by bleeding from a cerebellar cortical small artery. Most of the clots were removed, and hemostasis was achieved. The postoperative course was favourable. The patient became alert 2 weeks later, and was discharged with a very mild ataxic gait 2 months later. No post-traumatic hydrocephalus is seen as yet.

Posttraumatic hydrocephalus—A retrospective review

The authors retrospectively reviewed all cases of acquired hydrocephalus admitted to the Institute of Neurological Sciences, Glasgow, Scotland, within a 5-year period and encountered 17 cases of posttraumatic hydrocephalus. These represented 0.7% of 2374 cases of severe head injury. Hydrocephalus became symptomatic within 1 year from the time of injury in 16 of 17 cases. Meningitis, traumatic subarachnoid hemorrhage, posterior fossa mass, supratentorial clot with contralateral ventricular dilatation, and craniotomy contributed to the development of posttraumatic hydrocephalus. After shunting, eight patients (50%) improved markedly and four (25%) slightly.

Posttraumatic hydrocephalus.

Posttraumatic hydrocephalus is a treatable complication of head injury and can present with several different clinical syndromes. These include obtundation; simple failure to improve; a tetrad of psychomotor retardation, memory loss, gait trouble, and incontinence; and unusual symptoms including emotional disorder. Posttraumatic hydrocephalus seems to result from a blockage of cerebrospinal fluid (CSF) flow around the cerebral convexities. When the lumbar CSF pressure is consistently above 180 mm H2O, the hydrocephalus should be treated unless a contraindication to operation exists. Underlying brain injury from the trauma itself, however, may prevent recovery. When the typical symptoms of normal pressure hydrocephalus (NPH) are present, a shunt is also indicated. Decision-making is difficult when the patient has normal pressure, but is too injured to display the symptoms of NPH or has atypical symptoms. Overnight pressure recording, lumboventricular infusion testing, or cisternography may clarify whether a shunt is needed in this situation, but there is still considerable uncertainty about shunt prediction in this setting.

Cerebrospinal fluid myelin basic protein in hydrocephalus.

Immunoreactive myelin basic protein (MBP) levels were measured in cerebrospinal fluid (CSF) samples taken from 57 patients with active hydrocephalus (age range 3 weeks to 60 years). Of these patients, 28 (49%) had elevated MBP values (greater than 4.5 ng/ml). Elevated MBP levels were found in 44% of patients with congenital hydrocephalus, 75% of patients with posttraumatic hydrocephalus, 80% of patients with normal-pressure hydrocephalus, and 83% of patients with porencephaly. Also associated with abnormal MBP levels was the ventricular size as measured by computerized tomography scanning (chi 2: p less than 0.05): 36% of the patients with small ventricles (ventricle:brain ratio 0 to 0.4:1) had elevated MBP in the CSF, whereas 61% of those with moderate ventricles (0.41 to 0.6:1 ratio) and 100% of those with large ventricles (0.61 to 0.85:1 ratio) had abnormal values. Only 33% of those with maximal hydrocephalus (0.86 to 1.0:1 ratio) had elevated MBP levels, perhaps because of dilution effects. In three patients in whom CSF was obtained simultaneously by ventricular and lumbar punctures, the ventricular fluid had a consistently higher concentration of MBP, suggesting a cerebral origin. It is concluded that active hydrocephalus produces significant periventricular demyelination, probably as the result of mechanical stretching.

428 Prolactin and prognosis in advanced postmenopausal breast cancer

To describe incidence, clinical characteristics, complications, and outcomes in posttraumatic hydrocephalus (PTH) after traumatic brain injury (TBI) for patients treated in an inpatient rehabilitation program.Cohort study with retrospective comparative analysis.Inpatient rehabilitation hospital.All patients admitted for TBI from 2009 to 2013 diagnosed with PTH (N=59), defined as ventriculomegaly, delayed clinical recovery discordant with injury severity, hydrocephalus symptoms, or positive lumbar puncture results.None.Primary measures were incidence of PTH and patient and injury characteristics. Secondary measures included frequency and timing of ventriculoperitoneal (VP) shunt, related complications, emergence from and duration of posttraumatic amnesia (PTA), Rancho Los Amigos Scale (RLAS) score, and FIM score at rehabilitation admission and discharge.Of 701 patients with TBI admitted, 59 (8%) were diagnosed with PTH. Of these, the median age was 25 years, with 73% being men. At initial presentation, 52 (88%) did not follow commands. Fifty-two (90%) patients with PTH had a VP shunt placed. Median time from injury to shunt placement was 69 (range, 9–366) days. Seven (12%) patients with PTH experienced postsurgical seizure, 3 (6%) had shunt infection, and 7 (12%) had shunt malfunction. Thirty-six (61%) patients with PTH emerged from PTA during rehabilitation. Median total FIM score at rehabilitation admission was 20 (range, 18–76), and at discharge it was 43 (range, 18–118). Injury severity predicted outcome at rehabilitation admission, whereas shunt timing predicted outcome at rehabilitation discharge.Incidence of PTH was observed in 8% of patients with TBI in inpatient rehabilitation. Earlier shunting predicted improved outcome during rehabilitation. Future studies should prospectively examine clinical decision rules, type, and timing of intervention and the coeffectiveness of rehabilitation treatment on outcomes.

Computed tomography in the evaluation of incidence and significance of post-traumatic hydrocephalus.

Two hundred consecutive patients with severe head injury underwent sequential computed tomography (CT) on admission, after 4, 14, and 90 days, and after one year. Ventricular enlargement was evaluated in the surviving patients, based upon serial CT examinations. Significant ventricular enlargement was further evaluated with radionuclide cisternography. A significant correlation was shown between clinical outcome and presence or absence of ventricular enlargement. Radionuclide cisternography provided an additional means of determining those patients whose recovery was impaired by persistent obstruction of cerebrospinal fluid circulation and who would therefore benefit from cerebrospinal fluid shunting.

Posttraumatic epilepsy and CT scan.

Among 83 head-trauma cases examined by CT scan in a later year, 41 were included in a seizure group of those who clinically showed late epilepsy and who obviously showed epileptic discharge such as spike or spike and wave in EEG after trauma, and 42 were included in a nonseizure group of those who had some sequelae such as abnormal findings in EEG or neurologic defects: the CT findings of these 83 cases were collected and compared with clinical findings, EEG, and other data. The CT findings of these cases were divided into five groups: (A) a normal group; (B) a group showing partial or unilateral ventricular dilatation; (C) a group showing porencephaly in the cerebral parenchyma; (D) a group suspected of cortical atrophy; (E) a group of other cases. Group D contained 44.3% of the cases, and was the largest group; the frequency of seizure was highest in Group C. The CT classification reveals the contradiction of the conventional definition of posttraumatic epilepsy and also poses some problems concerning the disease. CT scan is mostly applied to head trauma in the acute stage, and as for trauma in the chronic stage there are a few reports on chronic subdural hematoma and post-traumatic hydrocephalus. We noticed posttraumatic epilepsy among the sequelae of trauma, and then analyzed CT findings of the epilepsy: the results are reported here.

Post-traumatic hydrocephalus in patients with severe head injury.

Computerized tomography was performed on 100 consecutive patients suffering from severe head injury, on admission, after 3, 5, 14, and 90 days and 1 year. Ventricular enlargement was evaluated in the surviving patients based upon serial CT examinations. The presence or absence of ventricular enlargement was correlated with the clinical outcome. The study indicates that a significant correlation does exist between the outcome and ventricular size. Hydrocephalus was seen in only four out of the 29 patients who developed ventriculomegaly.

Clinical, arteriographic, and cisternographic observations after removal of acute subdural hematoma.

The authors review 47 patients with closed-head injuries requiring treatment for acute subdural hematoma and report that 21 (45%) survived for 5 days or more. Follow-up study of these 21 survivors led to the following observations: that clinical evaluation of these patients is the most reliable index of their postoperative progress; that the diagnostic usefulness of postoperative cerebral arteriograms is limited because immediate postoperative changes tend to persist; that craniotomy is preferable to burr holes for removal of an acute hematoma; and that the value of cisternography, unless done serially, is limited since posttraumatic hydrocephalus develops rapidly and may persist indefinitely.