Acute Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

Canadian Journal of Neurological Sciences - Tập 23 Số 1 - Trang 40-45 - 1996
Vivek Mehta1, Renn O. Holness2, Kieran M. Connolly2, Simon Walling2, Richard Hall2
1Division of Neurosurgery, Dalhousie University, Victoria General Hospital, Halifax, Canada.
2Division of Neurosurgery and Department of Anaesthesia. Dalhousie University

Tóm tắt

ABSTRACT: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.

Từ khóa


Tài liệu tham khảo

10.1227/00006123-198601000-00003

Galera, 1970, Hydrocephalus in the adult secondary to the rupture of intracranial arterial aneurysms, J Neurosurg, 32, 634, 10.3171/jns.1970.32.6.0634

10.1001/archsurg.1928.01140070021002

Nomes, 1973, The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysms, J Neurosurg, 39, 226, 10.3171/jns.1973.39.2.0226

Raimondi, 1973, Acute hydrocephalus as a complication of subarachnoid hemorrhage, Surg Neurol, 1, 23

10.1227/00006123-198112000-00012

10.3171/jns.1973.39.4.0474

Spallone, 1983, Hydrocephalus following aneurysmal subarachnoid hemorrhage, Zentralbl Neurochir, 44, 141

10.1056/NEJM197010152831608

10.3171/jns.1968.28.1.0014

Rilter, 1986, Progressive postnatal dilatation of brain ventricles in spontaneously hypertensive rats, Brain Res, 370, 327, 10.1016/0006-8993(86)90488-9

10.1001/archneurpsyc.1944.02290360077006

10.1227/00006123-199005000-00012

10.1212/WNL.37.5.868

10.1002/ana.410310405

10.3171/jns.1979.51.3.0341

10.1161/01.STR.20.6.747

10.3171/jns.1969.30.6.0651

10.1001/archneur.1989.00520430038014

10.1227/00006123-198304000-00011

Mancuso, Ruptured Cerebral Aneurysms: Perioperative Management, 6, 124

10.3171/jns.1985.63.3.0355

10.3171/jns.1983.58.4.0482

10.1161/01.STR.14.4.628

10.3171/jns.1992.76.3.0422

Thông tin
Thông tin xuất bản

Canadian Journal of Neurological Sciences

Tập 23 Số 1

40-45

Thông tin tác giả