Hydrocephalus in Persistent Vegetative State

Kim, Jong Yeon; Hu, Chul; Whang, Kum; Hong, Soon Ki; Pyen, Jhin Soo; Han, Yong Pyo

Abstract

OBJECTIVE
The authors investigated the clinical influence of a shunt operation in hydrocephalic patients with persistent vegetative state (PVS) patients.
METHODS
39 patients with hydrocephalic PVS were included in this study. We analyzed the clinical outcome and prognosis according to clinical parameters, especially in relation to the shunt operation.
RESULTS
In 39 patients with hydrocephalic PVS, 26 underwent a shunt operation and 13 were treated conservatively. At the time of diagnosis of hydrocephalus in PVS, the mean Glasgow Coma Scale (GCS) and ventriculocranial ratio (VCR) were 5.31±0.85 and 0.24±0.05 in the conservative group, and 5.00±0.75 and 0.23±0.04 in the operative group. On the brain CT taken upon making the diagnosis of hydrocephalus, there were less cerebral infarctions (p=0.001) and more subarachnoid space (SAS) effacement (p=0.018) in the shunt operation group compared to the conservative group. After six months from an event causing PVS, the operative group showed an increased GCS score than the conservative group, a mean increase of 2.38±0.48 vs. 0.54±0.14 (p=0.002), and a decreased VCR, with a decrease in VCR 0.07±0.03 vs. 0.01±0.01 (p=0.021) respectively. With regard to the outcome, according to GOS, the younger aged and post-traumatic patients showed a better prognosis, especially those younger than 60 years (p=0.016) and the operation did good in the highly selected group than those in conservative care (p=0.009). But CSF flow study grade was not significant prognostic factor.
CONCLUSION
In hydrocephalic PVS patients, a better outcome and GOS may be anticipated in the case of highly selected patients of a younger age, less cerebral infarction and more SAS effacement preoperatively.