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Acute Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

Published online by Cambridge University Press:  18 September 2015

V. Mehta ,
R. O. Holness ,
K. Connolly ,
S. Walling  and
R. Hall
V. Mehta
Affiliation:
Division of Neurosurgery and Department of Anaesthesia. Dalhousie University, Victoria General Hospital. Halifax
R. O. Holness*
Affiliation:
Division of Neurosurgery and Department of Anaesthesia. Dalhousie University, Victoria General Hospital. Halifax
K. Connolly
Affiliation:
Division of Neurosurgery and Department of Anaesthesia. Dalhousie University, Victoria General Hospital. Halifax
S. Walling
Affiliation:
Division of Neurosurgery and Department of Anaesthesia. Dalhousie University, Victoria General Hospital. Halifax
R. Hall
Affiliation:
Division of Neurosurgery and Department of Anaesthesia. Dalhousie University, Victoria General Hospital. Halifax
*
Division of Neurosurgery, Rm. 2–111, Centennial Wing, Victoria General Hospital, Halifax, Nova Scotia, Canada B3H 2Y9
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Abstract:

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Background:

Acute hydrocephalus is a potentially treatable cause of early neurological deterioration after aneurysmal subarachnoid hemorrhage (§AH).

Methods:

A retrospective study of 105 consecutive cases of aneurysmal SAH was undertaken to determine those factors significantly related to the development of acute hydrocephalus. Acute hydrocephalus was diagnosed when the bicaudate index was greater than the 95,h percentile for age on a CT scan within 72 hours of the ictus.

Results:

Thirty-one percent of the patients developed acute hydrocephalus. Grade of SAH was a significant factor for the development of acute hydrocephalus on univariate analysis as 87% of patients with acute hydrocephalus (29/32) presented with at least grade 3 (Hunt-Hess) SAH (p < 0.05). In addition, posterior circulation aneurysms on univariate analysis were associated with acute hydrocephalus (p < 0.05). Both premorbid hypertension and intraventricular blood (p < 0.05) were predictors for acute hydrocephalus, whereas intracisternal blood, age and sex were not. On multivariate linear regression analysis, factors found to be significantly associated with acute hydrocephalus were premorbid hypertension, intraventricular blood, CSF diversion and definitive shunt procedures. External ventricular drainage was not associated with any instances of rebleeding. Thirty-seven percent (10/27) of patients with acute hydrocephalus who survived were improved by pre-operative external ventricular drainage.

Conclusions:

Patients with acute hydrocephalus following SAH can be safely treated with external ventricular drainage. Multiple factors can be identified to predict those patients who will develop acute hydrocephalus post aneurysmal rupture. Approximately 30% of those patients with acute hydrocephalus will require definitive shunt placement. Acute hydrocephalus occurred in 31% of aneurysmal SAH patients in this series.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 23 , Issue 1 , February 1996 , pp. 40 - 45
Copyright
Copyright © Canadian Neurological Sciences Federation 1996

References

1.Milhorat, TH.Acute hydrocephalus. N Engl J Med 1970; 283: 857–859.CrossRefGoogle ScholarPubMed
2.Spallone, A, Gagliandi, FM.Hydrocephalus following aneurysmal subarachnoid hemorrhage. Zentralbl Neurochir 1983; 44: 141–150.Google Scholar
3.Hasan, D, Tanghe, HLJ.Distribution of cisternal blood in patients with acute hydrocephalus after subarachnoid hemorrhage. Ann Neurol 1992; 31: 374–378.CrossRefGoogle ScholarPubMed
4.Graff-Radford, NR, Torner, J, Adams, HP, Kassell, NF.Factors Associated with Hydrocephalus after Subarachnoid Hemorrhage. A Report of the Cooperative Aneurysm Study. Arch Neurol 1989; 46: 744–752.CrossRefGoogle ScholarPubMed
5.Vassilouthis, J, Richardson, AE.Ventricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage. J Neurosurg 1979; 51: 341–351.CrossRefGoogle ScholarPubMed
6.Hasan, D, Vermeulen, M, Wijdicks, EFM, Hijdra, A, van Gijn, J.Management problems in acute hydrocephalus after subarachnoid hemorrhage. Stroke 1989; 20: 747–753.CrossRefGoogle ScholarPubMed
7.Galera, R, Greitz, T.Hydrocephalus in the adult secondary to the rupture of intracranial arterial aneurysms. J Neurosurg 1970; 32: 634–640.Google Scholar
8.Raimondi, AJ, Torres, H.Acute hydrocephalus as a complication of subarachnoid hemorrhage. Surg Neurol 1973; 1: 23–26.Google ScholarPubMed
9.Black, PM.Hydrocephalus and vasospasm after subarachnoid hemorrhage from ruptured intracranial aneurysms. Neurosurgery 1986; 18: 12–16.CrossRefGoogle ScholarPubMed
10.Ellington, E, Margolis, G.Block of arachnoid villus by subarachnoid hemorrhage. J Neurosurg 1969; 30: 651–657.CrossRefGoogle ScholarPubMed
11.Blasberg, R, Johnson, D, Fenstermacher, J.Absorption resistance of cerebrospinal fluid after subarachnoid hemorrhage in the monkey: effects of heparin. Neurosurgery 1981; 9: 686–690.CrossRefGoogle ScholarPubMed
12.Bagley, C.Blood in the cerebrospinal fluid. Resultant functional and organic alterations in the central nervous system. Experimental data. Arch Surg 1928; 17: 18–38.CrossRefGoogle Scholar
13.Doczi, T, Nemiessanyi, Z, Szegvary, Z, Huszka, E.Disturbances of cerebrospinal fluid circulation during the acute stage of subarachnoid hemorrhage. Neurosurgery 1983; 12: 435–438.CrossRefGoogle ScholarPubMed
14.Mancuso, PA, Weinstein, PR.Chapter 5G. Principles of management of subarachnoid hemorrhage: pathophysiology and management of hydrocephalus after subarachnoid hemorrhage. In: Ratcheson, RA, Wirth, FP, eds. Ruptured Cerebral Aneurysms: Perioperative Management Vol. 6: Concepts in Neurosurgery. Williams & Wilkins, 1994: 124–133.Google Scholar
15.Van Gijn, J, Hijdra, A, Wijdicks, EFM, Vermeulen, M, van Crevel, H.Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg 1985; 63: 355–362.CrossRefGoogle ScholarPubMed
16.Hunt, WE, Hess, RM.Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28: 14–20.CrossRefGoogle ScholarPubMed
17.Hammes, EM.Reaction of the meninges to blood. Arch Neurol Psychiatry 1944; 52: 505–514.CrossRefGoogle Scholar
18.Yasargil, MG, Yonekawa, Y, Zumstein, B, Stah, HJ.Hydrocephalus following spontaneous subarachnoid hemorrhage. J Neurosurg 1973; 39: 474–479.CrossRefGoogle ScholarPubMed
19.Rilter, S, Dinh, TT.Progressive postnatal dilatation of brain ventricles in spontaneously hypertensive rats. Brain Res 1986; 370: 327–332.Google Scholar
20.Graff-Radford, NR, Godersky, JC.Idiopathic normal pressure hydrocephalus and systemic hypertension. Neurology 1987; 37: 868–871.CrossRefGoogle ScholarPubMed
21.Mohr, G, Ferguson, G, Khan, M, et al. Intraventricular hemorrhage from ruptured aneurysm. J Neurosurg 1983; 58: 482–487.CrossRefGoogle ScholarPubMed
22.Nomes, H.The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysms. J Neurosurg 1973; 39: 226–234.Google Scholar
23.Heros, RC, Kistler, JP.Intracranial arterial aneurysm. An update. Stroke 1983; 14: 1–5.CrossRefGoogle ScholarPubMed
24.Pare, L, Delfino, R, Leblanc, R.The relationship of ventricular drainage to aneurysmal rebleeding. J Neurosurg 1992; 76: 422–427.CrossRefGoogle ScholarPubMed
25.Auer, LM, Mokry, M.Disturbed cerebrospinal fluid circulation after subarachnoid hemorrhage and acute aneurysm surgery. Neurosurgery 1990; 26: 804–809.CrossRefGoogle ScholarPubMed