Post-traumatic hydrocephalus: experience in 17 consecutive cases.

ABSTRACT

BACKGROUND: Ventriculomegaly after head injury is one of controversial debate. Currently there is no definite way to distinguish post-traumatic hydrocephalus (PTH) from cerebral atrophy. The favourable outcome is only from CSF shunting in patients with true post-traumatic hydrocephalus, not hydrocephalus exvacuo. METHOD: 17 patients with post-traumatic hydrocephalus were retrospectively reviewed from January 1993 to February 1996 to determine risk factors and guidelines for the management of this problem. RESULTS: These 17 patients represented 1.6 per cent of the 1080 head-injured patients seen at Songklanagarind Hospital during that period. 385 patients were classified as severe head injury in whom 7 were complicated with post-traumatic hydrocephalus. Our study found a high incidence of correlation between PTH and decompressive craniectomy. The late effect of decompressive craniectomy may cause CSF blockage around the convexities and hydrocephalus. The diagnoses were based on clinical manifestations and CT scan appearances. The outcome was related closely to the initial GCS score and the method used for diagnosis. CONCLUSION: Post-traumatic hydrocephalus was 1.8 per cent in patients with severe head injury. Late neurological deterioration confirmed by CT scan findings was more useful than CT scan findings alone. CSF shunting was effective in patients with ventriculomegaly who had clinical signs and symptoms of increased intracranial pressure from post-traumatic hydrocephalus.