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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

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