Delayed intracerebral hemorrhage after ventriculoperitoneal shunt insertion. Case report and literature review

Abstract

SummaryWe present another case of delayed intracerebral hemorrhage after a ventriculoperitoneal (VP) shunting procedure. In this case, a right occipital intraparenchymal hematoma and associated intraventricular hemorrhage occurred six days after the operation for hydrocephalus secondary to subarachnoid hemorrhage in a 64 year old woman. It is a rare complication of VP shunting, with few cases reported previously in the literature. The presumed mechanism is the erosion of a cerebral blood vessel secondary to a close contact with the ventricular catheter; bleeding disorder, vascular malformation, head trauma or brain tumor were excluded in this patient.KEY WORDS: Intracerebral hemorrhage. Ventriculoperioneal shunt. Hydrocephalus. Postoperative complication. Ventricular catheter.Hemorragia intracerebral tardía tras la colocación de una derivación ventriculoperitoneal. Caso clínico y revisión de la literatura Resumen Presentamos un caso de hemorragia intracerebral tardía tras la colocación de una derivación ventriculoperitoneal. Una paciente de 64 años de edad, con hidrocefalia secundaria a una hemorragia subaracnoidea, sufre una hemorragia intraparenquimatosa occipital derecha con hemorragia intraventricular secundaria seis días después de la intervención quirúrgica. Se trata de una complicación rara de la derivación ventriculoperitoneal, con pocos casos publicados anteriormente. El mecanismo supuesto es la erosión de un vaso sanguíneo secundaria a un íntimo contacto con el catéter proximal de la derivación; trastornos sanguí-neos, malformaciones vasculares cerebrales, traumatismo craneal o tumor cerebral fueron excluidos en esta paciente.PALABRAS CLAVE: Hemorragia intracerebral. Derivación ventriculoperitoneal. Hidrocefalia. Complicación postquirúrgica. Catéter ventricular.

Intracerebral Hemorrhage Secondary to Ventriculoperitoneal Shunt Insertion -Four Case Reports-

“…None of the 7 previous patients with postoperative intracerebral hemorrhage around the shunt tube presented with evidence of any of the above risk factors. 1,2,5,7,8) We divided the 7 previous and our 4 patients into 2 groups based on whether the hemorrhage occurred early (within 2 days of VP shunting, n ＝ 6, Group 1, Table 1) or late (5-13 days after VP shunting, n ＝ 5, Group 2, Table 2). Hemostasis of bleeding from a cortical vein was difficult in 2 of the 6 patients in Group 1.…”

“…Delayed hemorrhage occurred after shunt placement for hydrocephalus secondary to SAH in one patient, and delayed hemorrhage 2 years manifested after ipsilateral traumatic contusional hematoma leading to recent memory disturbance and epilepsy in another. 1,5) Therefore, 4 of the 5 patients in Group 2 presented with a primary brain disorder such as SAH, meningitis, or severe brain trauma prior to shunt placement. We suggest that tube cannulation into fragile brain tissue affected by a primary brain disorder was associated with the delayed development of an intracerebral hematoma.…”

“…The mechanism underlying the development of a delayed intraparenchymal hematoma after shunt placement may involve erosion of a cerebral blood vessel secondary to contact with the ventricular catheter, 1) or a similar mechanism. 8) However, this mechanism fails to explain all post-shunting hemorrhages because continuous contact must also occur between the ventricular catheter and blood vessels in many patients without this complication.…”

“…1,9) Intracerebral or intraventricular hemorrhage secondary to VP shunt placement is uncommon. Only 7 patients have been reported with this complication, and retrospective analysis revealed an incidence rate of 0.3-4.0%.…”

“…Only 7 patients have been reported with this complication, and retrospective analysis revealed an incidence rate of 0.3-4.0%. 1,2,5,7,8) The features of this complication are not clearly understood.…”