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Management problems in acute hydrocephalus after subarachnoid hemorrhage
D Hasan1, M Vermeulen, E F Wijdicks
1Department of Neurology, University Hospital Dijkzigt, Rotterdam, The Netherlands.
Stroke
|June 1, 1989
Summary
Acute hydrocephalus affects 19% of subarachnoid hemorrhage patients. Spontaneous improvement occurs in half of those with impaired consciousness, while ventricular drainage improves outcomes if rebleeding and infection are prevented.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH) frequently leads to acute hydrocephalus.
- Acute hydrocephalus can cause neurological deterioration in SAH patients.
- The management of acute hydrocephalus post-SAH requires careful consideration.
Purpose of the Study:
- To investigate the incidence and clinical course of acute hydrocephalus following subarachnoid hemorrhage.
- To evaluate the effectiveness and complications of ventricular drainage in managing acute hydrocephalus.
- To identify factors influencing outcomes in patients with SAH and acute hydrocephalus.
Main Methods:
- Retrospective analysis of 473 consecutive patients admitted within 72 hours of SAH.
- Assessment of initial computed tomography (CT) scans for hydrocephalus.
- Monitoring of clinical status, neurological deterioration, and interventions like ventricular drainage.
Main Results:
- 19% of SAH patients presented with hydrocephalus on initial CT.
- 39% of patients with acute hydrocephalus and impaired consciousness improved spontaneously within 24 hours.
- Ventricular drainage improved consciousness in 78% of patients, but external drainage was associated with ventriculitis.
- Rebleeding rates were higher in SAH patients with ventricular drainage compared to those without.
Conclusions:
- Spontaneous improvement is common in SAH patients with acute hydrocephalus and impaired consciousness.
- Ventricular drainage can improve neurological status but carries risks of infection and rebleeding.
- Preventing rebleeding and infection is crucial for improving outcomes in SAH patients requiring ventricular drainage.