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posttraumatic_hydrocephalus

Posttraumatic hydrocephalus

Posttraumatic hydrocephalus (PTH) is a complication secondary to traumatic brain injury, especially among patients keeping chronic unconscious.

Epidemiology

Etiology

see Hydrocephalus after decompressive craniectomy.

The incidence of PTH treated with shunt implantation was 4.8%. The mean age of the patients was 32 years (range 14-75 years). In 22 cases, the hydrocephalus was diagnosed in the rehabilitation unit (40%). Other patients were diagnosed and shunted before being transferred to rehabilitation 1).

Most cases of PTH emerge during rehabilitation. Therefore, attention towards this complication should be present also beyond the acute stage after TBI, particularly among older patients and patients with severe disordered consciousness 2).

Posttraumatic hydrocephalus risk

Treatment

The median time of shunting was 80 days (range 20-270 days) after brain trauma 3).

Outcome

It can lead to brain metabolic impairment and dysfunction and has a high risk of clinical deterioration and worse outcomes.

On the basis of scores of the functional independence measure, improvement could be observed in 43 cases (78%), the mean score improvement was 40 (2-81) 4).

Complications

Postoperative complications were seen in 10 patients (18%): four due to infections and six due to shunt failure. Revision was necessary in all 10 cases. Almost half of the diagnoses of PTH were established in the postacute rehabilitation unit, and all complications after shunt implantation were also recognized there. Precise clinical observation is necessary for diagnosis of PTH. Early diagnosis and treatment are important to prevent secondary complications 5).

Outcome

A proportion of patients who had PTH and remained in severe conscious disturbance would benefit from shunt implantation, and the improvement may turn up late after this procedure 6).

Several recent studies have indicated that high iron levels in brain may relate to hydrocephalus development after intracranial hemorrhage.

1) , 3) , 4) , 5)
Denes Z, Barsi P, Szel I, Boros E, Fazekas G. Complication during postacute rehabilitation: patients with posttraumatic hydrocephalus. Int J Rehabil Res.2011 Sep;34(3):222-6. doi: 10.1097/MRR.0b013e328346e87d. PubMed PMID: 21555949.
2)
Kammersgaard LP, Linnemann M, Tibæk M. Hydrocephalus following severe traumatic brain injury in adults. Incidence, timing, and clinical predictors during rehabilitation. NeuroRehabilitation. 2013;33(3):473-80. doi: 10.3233/NRE-130980. PubMed PMID: 23949078.
6)
Xin H, Yun S, Jun X, Liang W, Ye-Lin C, Xiao-Feng Y. Long-term outcomes after shunt implantation in patients with posttraumatic hydrocephalus and severe conscious disturbance. J Craniofac Surg. 2014 Jul;25(4):1280-3. doi: 10.1097/SCS.0000000000000583. PubMed PMID: 25006909.
posttraumatic_hydrocephalus.txt · Last modified: 2018/05/29 12:24 by administrador