Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage

Abstract

OBJECTIVE Acute and chronic hydrocephalus are common pathologies after aneurysmal subarachnoid hemorrhage (SAH). Generally, the presence of acute hydrocephalus is associated with elevated intracranial pressure (ICP) treated with a ventricular drain. Subsequently, however, pronounced hydrocephalus without elevated ICP may develop in some patients with SAH in the postacute phase. This is described as acute low-pressure hydrocephalus (aLPH), and there are very limited data in the literature of this pathology. The aim of this study was to evaluate the rate of and factors associated with aLPH and describe its clinical course. METHODS In this retrospective single-center cohort study, the frequency and clinical characteristics of SAH-associated aLPH were investigated. Acute LPH was defined as an increase in ventricular size as measured by the Evans index, ICP within the normal range (< 5 mm Hg) at the time of ventricular enlargement, and timely neurological improvement after indwelling ventricular CSF drainage with negative pressure up to 5 cm H2O below normal level. Demographic and SAH-specific factors in patients with SAH treated using an external ventricular drain were extracted from the electronic medical chart and further analyzed. RESULTS From November 2010 to May 2020, 15 (3.7.%) of 406 patients with SAH fulfilled the criteria for aLPH. Acute LPH was diagnosed after an average of 13.1 ± 7.7 days. The presence of IVH and its extension were associated with the occurrence of aLPH. After undergoing the transient phase of aLPH, these patients subsequently developed a chronic, typical malresorptive hydrocephalus requiring a ventriculoperitoneal shunt more often (66.7% vs 17.4%, p < 0.001) and stayed longer in the intensive care unit (27 vs 20.5 days, p = 0.043) and in the hospital (36.4 vs 26.3 days, p = 0.004). CONCLUSIONS Acute LPH is a rare pathology in patients with SAH and negatively impacts the clinical course. It should be especially considered in patients with a lack of neurological improvement, an increase in ventricular width, and normal ICP values, so that forced CSF drainage is implemented.

Cerebrospinal fluid drainage and chronic hydrocephalus in aneurysmal subarachnoid hemorrhage patients with intraventricular hemorrhage

“…However, multiple studies have shown that the amount of blood in the cerebral cistern, ventricle, or brain parenchyma after subarachnoid hemorrhage, as well as acute hydrocephalus, is associated with the formation of chronic hydrocephalus in patients with aSAH ( 19 , 20 ). Although the occurrence of hydrocephalus after aSAH has been well studied and some preventive measures have been taken, its potential risk factors are still unclear ( 21 – 23 ). Therefore, it is necessary to study the relationship between patients with intraventricular hemorrhage and the formation of chronic hydrocephalus, as well as how to reduce the incidence of chronic hydrocephalus.…”

Treatment of Pineal Region Lesions in Children

“…The modified Rankin Scale (mRS) and Karnofsky Performance Scale (KPS) were used to assess neurologic outcome. An mRS score ≤ 2 was defined as a favorable functional outcome and an mRS score ≥ 3 was defined as a poor functional outcome 10 …”

“…An mRS score ≤ 2 was defined as a favorable functional outcome and an mRS score ≥ 3 was defined as a poor functional outcome. 10…”

Low-/Negative-Pressure Hydrocephalus: To Understand the Formation Mechanism from the Perspective of Clinicians

“…Recent research suggests that the cerebral lymphatic system may be implicated in the etiology of aneurysmal SAH-induced acute low pressure hydrocephalus. 44 Meningeal lymphatic vessels have been recognized as an important player in the complex circulation and exchanges of soluble contents (cytokines) between the CSF and ISF. 45 The brain parenchyma produce a large portion of CSF and drained through the perivascular glymphatic system and meningeal lymphatic vessels into the blood.…”