Spontaneous resolution of cerebrospinal fluid obstruction due to intraventricular hemorrhage: A case report

Obstructive hydrocephalus is a serious and potentially life-threatening condition caused by the temporary blockage of cerebrospinal fluid (CSF) flow. Most cases require urgent intervention as spontaneous resolution is very uncommon. We present the case and brain imaging of a 63-year-old man who presented to the emergency department with complaint of headache, nausea, confusion, and dysarthria. Initial imaging showed a left caudate bleed with intraventricular hemorrhage and mild hydrocephalus secondary to obstruction of CSF in the aqueduct of Sylvius. External ventricular drain (EVD) was deferred due to mild symptoms and small intraventricular clot burden. The following day, he had marked improvement in mental status, and repeat head computed tomography showed spontaneous resolution of the obstruction without an EVD or intraventricular thrombolysis. This case demonstrates the importance of correlating clinical symptoms with imaging findings and close neuromonitoring. Mild symptoms, along with mild hydrocephalus and small clot burden, in addition to timely repeat imaging may avoid unnecessary invasive procedures.