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Rapid neurological deterioration associated with minor head trauma in chronic hydrocephalus
Rob D Dickerman1, Walter J McConathy, Elizabeth Lustrin
1Department of Neurosurgery, North Shore University--Long Island Jewish Health System, New Hyde Park, NY 11042, USA. drrdd@yahoo.com
Insights
A boy with chronic hydrocephalus experienced sudden neurological decline after minor head trauma. Prompt intervention with ventriculostomy and a shunt stabilized his condition, highlighting the risks in such cases.
Area of Science:
- Pediatric Neurosurgery
- Neurology
- Trauma Management
Background:
- This case report details a pediatric patient with a history of posterior fossa low-grade glioma, prior ventriculostomy, and arrested hydrocephalus.
- The patient presented with acute neurological deterioration following minor head trauma.
Observation:
- An 8-year-old boy with known ventriculomegaly experienced vomiting and lethargy post-head trauma.
- Emergency evaluation revealed no acute intracranial changes on CT but demonstrated elevated intracranial pressure via ventriculostomy.
- The patient's neurological status rapidly declined in the emergency department.
Findings:
- Rapid neurological decline in a patient with chronic hydrocephalus can be precipitated by minor head trauma.
- Elevated intracranial pressure was the likely cause of the acute deterioration.
- Timely cerebrospinal fluid diversion via ventriculostomy and subsequent ventriculoperitoneal shunt placement led to clinical improvement.
Implications:
- Minor head trauma can pose significant risks for patients with pre-existing hydrocephalus and ventriculomegaly.
- Prompt recognition and management of increased intracranial pressure are crucial in preventing severe neurological injury.
- This case underscores the importance of considering hydrocephalus status in pediatric head trauma evaluations.
Case Report:
An 8-year-old developmentally normal boy (status: post third ventriculostomy and resection of posterior fossa low-grade glioma 4 years earlier and with known history of ventriculomegaly/arrested hydrocephalus) presented to the emergency room with vomiting and lethargy after a minor head trauma. Computed tomography scan of the head revealed no acute changes since previous studies. However, the patient's neurological status rapidly declined in the emergency room, where an emergency ventriculostomy demonstrated increased intracranial pressure. The patient's clinical condition improved over 24 h: he underwent placement of a ventriculoperitoneal shunt without complications and was discharged intact.
Discussion:
The pathogenesis of rapid neurological decline associated with minor head trauma in chronic hydrocephalus is reviewed.