Acute hydrocephalus after aneurysmal subarachnoid hemorrhage

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Subarachnoid hemorrhage (SAH) survivors face risks of secondary complications.
• Hydrocephalus is a potential complication following SAH.
• Early identification and management of hydrocephalus are crucial for patient outcomes.

Purpose of the Study:

• To determine the incidence of acute hydrocephalus in SAH patients.
• To investigate the relationship between hydrocephalus and factors like intraventricular blood and cisternal hemorrhage.
• To analyze the clinical features, diagnosis, and mortality associated with acute hydrocephalus post-SAH.

Main Methods:

• Prospective study of 174 SAH patients surviving the first 24 hours.
• Computerized tomography (CT) scanning performed within 72 hours of SAH.
• Bicaudate index used to define hydrocephalus (above 95th percentile for age).

Main Results:

• Hydrocephalus was diagnosed in 34 (20%) patients.
• Acute hydrocephalus correlated with intraventricular blood, not cisternal hemorrhage extent.
• Mortality was significantly higher in patients with hydrocephalus (p < 0.001), mainly due to cerebral infarction.
• Hyponatremia was a frequent factor in deaths from infarction.

Conclusions:

• Acute hydrocephalus is a common and serious complication of SAH.
• Diagnosis relies heavily on CT imaging, as clinical signs are not always present.
• Hydrocephalus significantly increases SAH mortality, with cerebral infarction and hyponatremia being key contributors.