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Hydrocephalus: Obliterated Perimesencephalic Cisterns and the Danger of Sudden Death

Published online by Cambridge University Press:  18 September 2015

Marjorie A. Garvey  and
Robert Laureno
Marjorie A. Garvey
Affiliation:
Department of Neurology, Washington Hospital Center, and George Washington University Medical Center, Washington, DC
Robert Laureno*
Affiliation:
Department of Neurology, Washington Hospital Center, and George Washington University Medical Center, Washington, DC
*
Department of Neurology, Washington Hospital Center, 110 Irving Street, NW Washington, District of Columbia, U.S.A. 20010
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Abstract:

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Objective:

We report a possible risk factor which could identify patients with chronic hydrocephalus who are at risk for sudden death.

Methods:

A retrospective review of medical records and computed tomographic (CT) scans was conducted on three patients with chronic hydrocephalus who suffered acute cardiorespiratory arrest without those signs which are normally associated with a progressive worsening of hydrocephalus.

Results:

All three of these patients were awake and communicative shortly before the life threatening or terminal event. All had experienced some recent worsening of neurologic signs or symptoms, but none had shown a progressive impairment of consciousness or major neurologic decline ordinarily associated with life threatening elevation of intracranial pressure. Absence of the perimesencephalic cisterns on head CT scans done prior to or just after the life threatening event was the only new radiologic finding common to all these patients.

Conclusions:

The absence of the perimesencephalic cisterns in an awake and alert patient with severe hydrocephalus indicates that the patient may be at risk for neurogenic cardiorespiratory failure. In such cases, (especially when there has been a recent, albeit mild, change in neurologic signs or symptoms), the neurologist should urge emergency ventriculostomy or shunting for the hydrocephalus.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue 2 , February 1998 , pp. 154 - 158
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

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