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Brainstem Hemorrhage Following Lumbar Drain for Post-traumatic Hydrocephalus
Matthew T Carr1, Jeffrey Gilligan1, Zachary L Hickman1,2
1Neurosurgery, Mount Sinai Hospital, New York, USA.
Cureus
|July 29, 2022
Summary
Post-traumatic hydrocephalus is common after traumatic brain injury. Lumbar drains, used to manage this, can rarely cause fatal brainstem hemorrhage, even months after decompressive craniectomy.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Post-traumatic hydrocephalus frequently complicates severe traumatic brain injury (TBI), especially after decompressive craniectomy.
- Cerebrospinal fluid (CSF) management, including lumbar drains (LDs), is crucial for addressing hydrocephalus and elevated intracranial pressure (ICP).
Observation:
- A case is presented of a 32-year-old male with TBI and subdural hematoma, who underwent decompressive craniectomy and ventriculostomy.
- Three months post-injury, the patient developed communicating hydrocephalus and an LD was placed for CSF removal.
- Five days after LD placement, the patient experienced a fatal brainstem hemorrhage.
Findings:
- Hemorrhagic complications from LDs are rare but can be catastrophic, including intracranial hemorrhage.
- This case highlights a fatal brainstem hemorrhage occurring after LD placement in a patient with a history of decompressive craniectomy.
Implications:
- Neurosurgeons must be aware of the potential for severe intracranial hemorrhage, specifically brainstem hemorrhage, as a complication of LDs in patients with TBI and prior craniectomy.
- This underscores the need for careful patient selection and monitoring when utilizing LDs for post-traumatic hydrocephalus management.
