Post-traumatic hydrocephalus: Presentation, management and outcome — An apex trauma centre experience

Abstract

The reported incidence of post-traumatic hydrocephalus (PTH) in literature varies from 0.7?29%. It is a treatable complication of head injury and presents with different clinical syndromes. We manage 38 cases of post-traumatic hydrocephalus in our hospital between January 2009 and April 2010. Clinicoradiology was studied at initial trauma, and at presentation with symptoms suggestive of increased ICP. Post ventriculo-peritoneal shunt outcome was analyzed. Sixty-eight percent cases were of severe head injury. Contusions (73.6%) and SAH (50%) were the most common CT findings. Sixty-five percent cases had been managed by decompressive craniectomy at the time of initial injury. Deterioration in consciousness (57.8%) and hemiparesis (26.3%) were most common presenting features of PTH, usually after 65?38 days (mean?SD) of initial injury. Patients were managed by antibiotic impregnated ventriculo-peritoneal shunt. Shunt revision and infection rates were 18.4% and 12.8% respectively. Thirty cases (78.9%) improved, 2 (5.2%) showed no improvement and 6 (15.7%) died. PTH is a treatable complication of head injury with a favorable outcome and therefore should be aggressively managed by CSF shunting.

Posttraumatic Hydrocephalus after Decompressive Craniectomy in 126 Patients with Severe Traumatic Brain Injury

“…10,27,34 DC per se, extremely high ICP before DC, delayed cranioplasty, intraventricular hemorrhage, low postresuscitation GSC score, and higher age had been proposed by some to be associated with PTH. 10,20,26,27,33,34,[36][37][38][39][40] In our study, there seemed to be no statistical correlation between the risk for the development of PTH and age or sex, but there is, in agreement with previous studies, a statistically significant correlation between PTH and the size of DC,. 6,25 How DC can contribute to the development of PTH?…”

Theco-peritoneal shunt for post-traumatic hydrocephalus – A valuable adjunct?

“…Patient improvement has been reported after VP shunt for PTH in 78.9% of patients in a previous study done at our centre. 12 In the current study, 77.3% patients showed improvement. In a study done by Aoki, 18 comparing TP shunt and VP shunts, incidence of shunt infection and malfunction was lower in TP shunt.…”

“…11 Clinical presentation may vary from seizures, memory loss, gait ataxia, urinary incontinence to obtundation, arrest in neurological improvement and prolonged coma. 12 On fundus examination papilloedema may be revealed in such patients. PTH may occur as early as within 7 h of injury, 13 however in our series 1 patient was diagnosed on day 15th post trauma and as late as 421 days post trauma.…”

“…Shunt revision rates of 11%e50% have been reported in various case series. 17 Sarkari et al 12 reported VP shunt infection and revision rates of 12.8% and 18.4%, and respectively in PTH. In our study, rates of malfunction and revision were slightly higher (22.7%, 5 cases).…”

Lateral Ventricle to Sylvian Fissure Shunt for Obstructive Hydrocephalus: First Report

“…2 Neuroimaging (CT) often cannot differentiate between the CSF blockage at the outlet of the fourth ventricle or at the arachnoid granulations in the superior sagittal sinus. [3][4][5] Lumbar puncture is used to diagnose posttraumatic hydrocephlaus. In our case, 3 lumbar punctures were performed, because no pronounced clinical improvement was detectable; transient improvement in CSF circulation could explain this finding.…”