Clinical Feature and Outcomes of Secondary Hydrocephalus Caused by Head Trauma / 대한신경손상학회지

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.

Dementia Caused by Post-traumatic Hydrocephalus Showing Marked Improvement After a Shunt Operation

A few cases of dementia caused by posttraumatic hydrocephalus have been reported. A 75-year-old man was admitted to hospital for the evaluation of cognitive impairment and gait disturbance of 2 weeks duration. The patient had been involved in a car accident 50 days prior to his admission. A brain MRI revealed significant hydrocephalus. His score on the Korean version of the Mini Mental State Examination was 14/30, and a neuropsychological assessment revealed severe impairments in all domains. A lumboperitoneal shunt operation was performed. His global cognitive functions and daily activities were fully recovered after the procedure.

Result of Shunt Operation for Post-traumatic Hydrocephalus

We retrospectively reviewed all cases of hydrocephalus shunted in the Soonchunhyang University Hospital within a 5-year period and encountered 12 cases of posttraumatic hydrocephalus. When admitted, seven patients had a Glasgow Coma Scale value of 8 or less and, of the five patients with a Glasgow Coma Scale value above 8, two had an intraventricular hemorrhage, two had a subarachnoid hemorrhage alone. The mean interval from injury to the shunt was 110 days(range from 4 to 311 days). The intracranial pressure was measured by lumbar puncture in eight patients. It was less then 200mmCSF in five patients and above 200mmCSF in three patients. After shunting, six patients(50%) improved markedly and four(33%) slightly. Overall outcome was good recovery in three, moderate disability in three, severe disability in three, vegetative state in two, and death in one patient. Several prognostic factors such as Glasgow Coma Scale value on admission, CT findings, intracranial pressure, interval from injury to the shunt, degree of cortical atrophy, and surgical method are not related to the result of the shunt(p>0.1 by Fisher's test). Since there are no accurate predictors for the result of shunt at present, one can not be sure that the patient with negative prognostic factors will not improve. Shunting rather than simple observation could be a suitable therapeutic trial especially for the bedridden patients.