J Clin Neurol.  2013 Jul;9(3):192-195. 10.3988/jcn.2013.9.3.192.

Transient Obstructive Hydrocephalus due to Intraventricular Hemorrhage: A Case Report and Review of Literature

• Lusis EA
• Vellimana
• Ray WZ
• Chicoine M
• Jost SC

• KMID: 2287558
• DOI: http://doi.org/10.3988/jcn.2013.9.3.192

Abstract

BACKGROUND
Acute transient obstructive hydrocephalus is rare in adults. We describe a patient with intraventricular hemorrhage (IVH) who experienced the delayed development of acute transient hydrocephalus.
CASE REPORT
A 33-year-old man with a previously diagnosed Spetzler-Martin Grade 5 arteriovenous malformation presented with severe headache, which was found to be due to IVH. Forty hours after presentation he developed significant obstructive hydrocephalus due to the thrombus migrating to the cerebral aqueduct, and a ventriculostomy placement was planned. However, shortly thereafter his headache began to improve spontaneously. Within 4 hours after onset the headache had completely resolved, and an interval head CT scan revealed resolution of hydrocephalus.
CONCLUSIONS
In patients with IVH, acute obstructive hydrocephalus can develop at any time after the ictus. Though a delayed presentation of acute but transient obstructive hydrocephalus is unusual, it is important to be aware of this scenario and ensure that deterioration secondary to thrombus migration and subsequent obstructive hydrocephalus do not occur.

Keyword

acute hydrocephalus; intraventricular hemorrhage; arteriovenous malformation; transient hydrocephalus

MeSH Terms

Adult
Arteriovenous Malformations
Cerebral Aqueduct
Dietary Sucrose
Head
Headache
Hemorrhage
Humans
Hydrocephalus
Thrombosis
Ventriculostomy
Dietary Sucrose

Figure

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  Fig. 1 A and B: Axial CT scan without contrast obtained at presentation demonstrates intraventricular hemorrhage within the left frontal horn, right occipital horn, and the third ventricle without evidence of ventriculomegaly.

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  Fig. 2 A and B: Anteroposterior (A) and lateral (B) cerebral angiograms demonstrate the patient's large left parietal AVM with primary blood supply from branches of the left middle cerebral artery and also the anterior and posterior cerebral arteries. C: Axial T2-weighted MRI scan demonstrating multiple flow voids within the AVM. AVM: arteriovenous malformation.

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  Fig. 3 A and B: Axial CT scan obtained 40 hours after presentation reveals the interval development of hydrocephalus with suggestion that a portion of the intraventricular thrombus had migrated from the left lateral ventricle to the junction of the third ventricle and cerebral aqueduct.

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  Fig. 4 A and B: Axial CT scan obtained approximately 6 hours after the development of hydrocephalus reveals resolution of the hydrocephalus and disappearance of the third-ventricle clot.

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