Artikel
Diagnosis and treatment of post-traumatic hydrocephalus in early rehabilitation
Diagnostik und Behandlung des posttraumatischen Hydrozephalus in der Frührehabilitation
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Autoren
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Rainer Joachim Strege
- Abteilung für Neurochirurgie, Stereotaxie und Frührehabilitation, Klinikum Plau am See, Plau am See
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P. Schumann
- Abteilung für Neurochirurgie, Stereotaxie und Frührehabilitation, Klinikum Plau am See, Plau am See
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K. Terstegge
- Abteilung für Neuroradiologie, Klinikum Plau am See, Plau am See
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E. Donauer
- Abteilung für Neurochirurgie, Stereotaxie und Frührehabilitation, Klinikum Plau am See, Plau am See
| Veröffentlicht: | 23. April 2004 |
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Gliederung
Text
Objective
Diagnosis and proper treatment of post-traumatic hydrocephalus (PTH) are important issues in the management of patients after severe head injury (SHI), especially in the early rehabilitation. Correct diagnosis of PTH may be difficult. We report our experience with PTH in early rehabilitation over a 5-year period.
Methods
The charts of all early rehabilitation patients between 6/1998 and 5/2003 were retrospectively analysed for diagnosis and treatment of PTH with special focus on the outcome.
Results
Fourteen (11.6%) of 120 SHI patients (10 men, 4 women) had ventriculomegaly interpreted as PTH and treated by ventriculo-peritoneal shunting. Besides two patients who were shunted elsewhere before being transferred to our hospital, the patients had non-programmable Hakim valves (NMT Neurosciences) in 11 cases and the HAKIMTM programmable valve (Codman) in one. The median time point of diagnosis was 38.5 (range: 15-467) days after SHI and the time point of shunting 55 (range: 20-489) days. The time point of shunting was delayed by intercurrent infections in 7 cases. Post-operative complications were seen in 3 of 12 patients (1x sepsis prompting shunt revision, 1x hygroma inducing temporary shunt ligation and 1x slit ventricles resulting in implantation of a shunt assistant). Post-operative neurological improvement was seen in 9 of 12 (75%) patients being shunted in our hospital and corresponded to GCS scores. The median GCS score at the time of PTH diagnosis was 7 (range: 4-13) and 11 (range: 6-15) at discharge 0.5-9 months (median: 3 months) after shunting. Unchanged neurological condition was observed in 3 of 12 cases. Morphological CCT- or MRI-signs of decreasing hydrocephalus were seen in 11 of 12 patients and did not correlate very well with their neurological rehabilitation. Clinical improvement after spinal tap test proved to be the best predictor of a favourable outcome.
Conclusions
On the basis of our data, PTH may be encountered in more than 10% of early rehabilitation patients after SHI. Precise clinical observation facilitates correct diagnosis of PTH by CT imaging in combination with spinal tap testing so that surgical shunting enables neurological improvement in the majority of these cases.
