Spontaneous acute subdural hematoma due to intracranial hypotension secondary to lumboperitoneal shunt: a case report and review of the literature

Abstract

Objective: To report a rare case with spontaneous intracranial acute subdural hematoma due to overdrainage of cerebrospinal fluid after lumboperitoneal shunting and to review the literature on this topic. Case report: A 53-year-old lady with spontaneous acute subdural hematoma developing 3 years after lumboperitoneal shunting for treatment of benign intracranial hypertension is reported. She was treated with shunt removal and hematoma evacuation. Material and Methods: We found 16 cases with intracranial bleeding developing spontaneously or after mild head injury after lumboperitoneal shunting. The characteristics of the patients were recorded, the outcome was given according to the Glasgow Outcome Scale, and a Glasgow Outcome Scale score from 1-3 was accepted as worse outcome. The factors affecting outcome were evaluated. Results: There were 10 females and 7 males aged 59.7±15.1 years. In most cases, the primary disease treated by lumboperitoneal shunting was hydrocephalus or benign intracranial hypertension. In 12 of the cases, the bleeding happened into the subdural space and in 5 into other compartments (intracerebral or subarachnoid bleeding). Five of the cases died, and 62.5% had a worse outcome. The only factor affecting outcome was the time span from lumboperitoneal shunting to intracranial bleeding. This time was significantly shorter in the patients with worse outcome (3.7 versus 38.6 months). Conclusions: Lumboperitoneal shunting may cause serious complications such as intracranial bleeding due to overdrainage of cerebrospinal fluid via shunt. Patients with lumboperitoneal shunting must be followed very closely for development of intracranial hypotension especially during the first few months after shunting. Keywords: acute subdural hematoma, intracranial hemorrhages, intracranial hypotension, lumboperitoneal shunting ÖZETLumboperitoneal şanta bağlı gelişen spontan akut subdural hematom: Olgu sunumu ve literatür taraması Amaç: Lumboperitoneal şant uygulanması sonrası beyin omurilik sıvısının aşırı drenajına bağlı spontan kafaiçi akut subdural hematom gelişen nadir bir olgunun sunulması ve bu konuda literatür taraması yapılması. Olgu Sunumu: Benign kafaiçi hipertansiyon tedavisi için lumboperitoneal şant uygulanmasından 3 yıl sonra spontan akut subdural hematom gelişen 53 yaşında kadın olgu sunuldu. Hasta şantın çıkarılması ve hematomun boşaltılması ile tedavi edildi. Yöntem ve Gereçler: Literatürde lumboperitoneal şant takılması sonrası kendiliğinden ya da hafif kafa travmasıyla kafa içi kanama gelişen 16 olgu bulduk. Hastalıkların özellikleri kaydedildi, sondurum Glasgow sondurum skalasına göre verildi ve Glasgow sondurum skala derecesi 1-3 olması kötü sonuç olarak kabul edildi. Sondurumu etkileyen faktörler değerlendirildi. Bulgular: Toplam 10 kadın ve 7 erkek olgu vardı, yaşları 59.7±15.1 idi. Lumboperitoneal şantla tedavi edilen asıl hastalık olguların çoğunda hidrosefali ya da benign kafaiçi hipertansiyondu. Olguların 12'sinde kanama subdural alana, 5'inde diğer kompartmanlaraydı (intraser...