Korean J Neurotrauma.  2018 Oct;14(2):86-92. 10.13004/kjnt.2018.14.2.86.

Clinical Feature and Outcomes of Secondary Hydrocephalus Caused by Head Trauma

• Yoon JE
• Lee CY
• Sin EG
• Song J
• Kim HW

• KMID: 2424318
• DOI: http://doi.org/10.13004/kjnt.2018.14.2.86

Abstract

OBJECTIVE
Post-traumatic hydrocephalus (PTH) is a frequent and serious complication following brain injury. The incidence of PTH varies greatly among studies. The purpose of this study was to investigate the incidence and treatment of PTH in patients with head trauma.
METHODS
We examined 956 patients with head trauma who visited our center from January 2012 to December 2015. The hydrocephalus diagnosis was based on radiologic findings and clinical features, and patients were classified into the mild (Group 1, Glasgow Coma Scale score [GCS] 13-15), moderate (Group 2, GCS 9-12), or severe (Group 3, GCS 3-8) brain injury group according to their GCS at admission. To compare these groups, we used age, gender, radiologic findings, PTH developmental period, and postoperative results (Glasgow Outcome Scale).
RESULTS
Of the 956 patients, 24 (2.5%) developed PTH. PTH occurred in 11 (1.4%), 3 (5.6%), and 10 (7.0%) patients in Groups 1, 2, and 3, respectively. Of the 24 patients with PTH, 22 (91.7%) developed PTH within 12 weeks post-trauma; the higher the GCS, the later the onset, and the lower the GCS, the earlier the onset (p=0.019). Twenty-one patients underwent ventriculoperitoneal shunting, and 13 had improved symptoms.
CONCLUSION
The incidence of PTH cannot be ignored. The possibility of PTH needs to be considered in patients with head trauma and appropriate follow-up should be undertaken. PTH is a treatable complication and patients' quality of life and neurological status can be improved if the appropriate treatment is selected and applied.

Keyword

Glasgow coma scale; Posttraumatic hydrocephalus; Traumatic brain injury

MeSH Terms

Brain Injuries
Craniocerebral Trauma*
Diagnosis
Follow-Up Studies
Glasgow Coma Scale
Head*
Humans
Hydrocephalus*
Incidence
Quality of Life
Ventriculoperitoneal Shunt

Reference

1. Albeck MJ, Skak C, Nielsen PR, Olsen KS, Børgesen SE, Gjerris F. Age dependency of resistance to cerebrospinal fluid outflow. J Neurosurg. 1998; 89:275–278. PMID: 9688123.

2. Bhatoe HS, Batish VK. Post head injury hydrocephalus. Indian J Neurotrauma. 2005; 2:131–133.

3. Choi I, Park HK, Chang JC, Cho SJ, Choi SK, Byun BJ. Clinical factors for the development of posttraumatic hydrocephalus after decompressive craniectomy. J Korean Neurosurg Soc. 2008; 43:227–231. PMID: 19096601.

4. Daou B, Klinge P, Tjoumakaris S, Rosenwasser RH, Jabbour P. Revisiting secondary normal pressure hydrocephalus: does it exist? A review. Neurosurg Focus. 2016; 41:E6.

5. Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci. 1965; 2:307–327. PMID: 5889177.

6. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975; 1:480–484. PMID: 46957.

7. Kammersgaard LP, Linnemann M, Tibæk M. Hydrocephalus following severe traumatic brain injury in adults. Incidence, timing, and clinical predictors during rehabilitation. NeuroRehabilitation. 2013; 33:473–480. PMID: 23949078.

8. Kawakami K, Yoshino H, Igarashi H, Chiba Y, Yoshino G, Hirose T. A case of idiopathic normal pressure hydrocephalus in an elder diabetic patient. Nihon Ronen Igakkai Zasshi. 2017; 54:186–190. PMID: 28592739.

9. Kishore PR, Lipper MH, Miller JD, Girevendulis AK, Becker DP, Vines FS. Post-traumatic hydrocephalus in patients with severe head injury. Neuroradiology. 1978; 16:261–265. PMID: 740188.

10. Low CY, Low YY, Lee KK, Chan SP, Ang BT. Post-traumatic hydrocephalus after ventricular shunt placement in a Singaporean neurosurgical unit. J Clin Neurosci. 2013; 20:867–872. PMID: 23415060.

11. Marmarou A, Foda MA, Bandoh K, Yoshihara M, Yamamoto T, Tsuji O, et al. Posttraumatic ventriculomegaly: hydrocephalus or atrophy? A new approach for diagnosis using CSF dynamics. J Neurosurg. 1996; 85:1026–1035. PMID: 8929491.

12. Marmarou A, Young HF, Aygok GA, Sawauchi S, Tsuji O, Yamamoto T, et al. Diagnosis and management of idiopathic normalpressure hydrocephalus: a prospective study in 151 patients. J Neurosurg. 2005; 102:987–997. PMID: 16028756.

13. Mazzini L, Campini R, Angelino E, Rognone F, Pastore I, Oliveri G. Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome. Arch Phys Med Rehabil. 2003; 84:1637–1641. PMID: 14639563.

14. McAllister JP 2nd, Williams MA, Walker ML, Kestle JR, Relkin NR, Anderson AM, et al. An update on research priorities in hydrocephalus: overview of the third National Institutes of Healthsponsored symposium “Opportunities for Hydrocephalus Research: Pathways to Better Outcomes”. J Neurosurg. 2015; 123:1427–1438. PMID: 26090833.

15. Ojemann RG, Fisher CM, Adams RD, Sweet WH, New PF. Further experience with the syndrome of “normal” pressure hydrocephalus. J Neurosurg. 1969; 31:279–294. PMID: 5811831.

16. Poca MA, Sahuquillo J, Mataro M, Benejam B, Arikan F, Báguena M. Ventricular enlargement after moderate or severe head injury: a frequent and neglected problem. J Neurotrauma. 2005; 22:1303–1310. PMID: 16305318.

17. Sarkari A, Gupta DK, Sinha S, Kale SS, Mahapatra AK. Post-traumatic hydrocephalus: Presentation, management and outcome - An apex trauma centre experience. Indian J Neurotrauma. 2010; 7:135–138.

18. Sheffler LR, Ito VY, Philip PA, Sahgal V. Shunting in chronic posttraumatic hydrocephalus: demonstration of neurophysiologic improvement. Arch Phys Med Rehabil. 1994; 75:338–341. PMID: 8129589.

19. Tian HL, Xu T, Hu J, Cui YH, Chen H, Zhou LF. Risk factors related to hydrocephalus after traumatic subarachnoid hemorrhage. Surg Neurol. 2008; 69:241–246. PMID: 17707493.

20. Tsuang FY, Huang AP, Tsai YH, Chen JY, Lee JE, Tu YK, et al. Treatment of patients with traumatic subdural effusion and concomitant hydrocephalus. J Neurosurg. 2012; 116:558–565. PMID: 22175725.

21. Waziri A, Fusco D, Mayer SA, McKhann GM 2nd, Connolly ES Jr. Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke. Neurosurgery. 2007; 61:489–493. PMID: 17881960.

22. Yoshimine T, Hayakawa T, Kamikawa K, Ohnishi T, Yamamoto K. Partial hydrocephalus with chronic subdural hematoma. Neurosurgery. 1982; 11:698–702. PMID: 6984144.