Rational management of transient obstructive hydrocephalus secondary to a cerebellar infarct

Cerebrovascular disease is a common occurrence in adults with immediate as well as long-term neurological effects. Sequelae are disabling for patients and lead to a greater demand for healthcare infrastructure and search for treatment options. The acute phase in a cerebellar infarction may become complicated with transient obstructive hydrocephalus, subsequent intracranial hypertension, and the need for surgical management. Although many patients respond well to medical treatment, clinical findings and neuroimaging methods must be considered to determine whether the hydrocephalus can be surgically treated in a timely fashion. A series of cases is presented and a proposal is made for adding endoscopic third ventriculostomy to the available treatment armamentarium.

Fourteen patients with cerebellar strokes and their clinical course are reported. Six required surgery for hydrocephalus management. Three of the cases had an endoscopic third ventriculostomy without complications, the rest were managed conservatively. As an average, patency was re-established in the aqueduct three months post ictus.

Management of obstructive hydrocephalus in the acute phase of a cerebellar stroke must be individualized. In cases with transient obstructive hydrocephalus, endoscopic third ventriculostomy is a good surgical treatment option that avoids the risks of a long-term ventricular shunt.