Delayed transient obstructive hydrocephalus after cerebral aneurysm rupture: A case report.

Obstructive hydrocephalus (OH) is a known complication following cerebral aneurysm rupture. Most cases develop early after the event and require immediate treatment. Prior research has shown that OH typically arises due to blood clots blocking cerebrospinal fluid pathways. However, delayed OH is rare and poorly understood. No prior work had resolved how OH might manifest days after aneurysm rupture. This gap motivated the authors to report a unique case of delayed transient OH. The patient’s condition did not align with typical early-onset OH patterns. This case highlights the need for continued monitoring in post-aneurysm patients. Understanding delayed OH could improve diagnostic and treatment approaches.

The aim of this case report is to describe a rare instance of delayed transient OH following cerebral aneurysm rupture. The specific problem is the lack of awareness regarding delayed OH manifestations. The patient’s condition was unusual because OH typically occurs early after aneurysm rupture. The authors sought to document the clinical course and treatment response in this case. By sharing this report, they aim to raise awareness among clinicians. The motivation stems from the limited literature on delayed OH. This case provides insights into the variability of OH onset. It also emphasizes the importance of prolonged monitoring in such patients.

The study is a single-patient case report based on clinical observation and treatment. The patient was a 64-year-old woman who underwent coil embolization for a ruptured anterior communicating artery aneurysm. Nineteen days post-rupture, she developed delayed OH with a fluctuating neurological status. The diagnosis was made through clinical presentation and imaging findings. CT scans were used to assess ventricular size and blood clot presence. Intracranial pressure was managed with mannitol administration. The patient’s recovery was monitored over 30 days. Follow-up imaging confirmed resolution of hydrocephalus.

The patient experienced a dramatic cycle of consciousness changes over 9 hours. This included wakefulness, drowsiness, coma, and return to wakefulness. Nineteen days post-rupture, delayed OH was diagnosed. The patient received mannitol to reduce intracranial pressure. At discharge, her GCS score was 15 with no neurological deficits. Follow-up brain CT showed no recurrence of hydrocephalus. The case suggests that even small blood clots in the ventricle may cause OH. Prolonged bed rest may reduce the risk of delayed OH. These findings highlight the variability in OH onset and resolution.

The authors propose that delayed transient OH is a rare but possible complication after cerebral aneurysm rupture. Their findings suggest that OH may develop even 19 days post-rupture. The patient’s fluctuating neurological status supports this possibility. The successful use of mannitol indicates a potential treatment approach. The absence of recurrence at follow-up supports the effectiveness of treatment. The case suggests that prolonged bed rest may help prevent delayed OH. These results emphasize the need for extended monitoring in post-aneurysm patients. The authors conclude that delayed OH should be considered in differential diagnosis.