Artikel
Low-pressure hydrocephalus after aneurysmal subarachnoid haemorrhage
Niedrigdruck-Hydrocephalus nach Aneurysmatischer Subarachnoidalblutung
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Veröffentlicht: | 25. Mai 2022 |
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Objective: Acute and chronic hydrocephalus are common pathologies after aneurysmal subarachnoid hemorrhage (SAH). In general, presence of hydrocephalus is associated with an elevated intracranial pressure (ICP). Nevertheless, in some SAH patients hydrocephalus without elevated ICP is present and described as low-pressure hydrocephalus with very limited data in the literature. Aim of this study was to evaluate the rate and associated factors with low-pressure hydrocephalus.
Methods: In this retrospective single-center cohort study from 11/2010 to 05/20 patients with SAH and low-pressure hydrocephalus were evaluated. Low-pressure hydrocephalus was defined as follows: 1) Increase of ventricular size measured by Evans index; 2) ICP within normal range (< 15mmHg) at time of ventricular enlargement; and 3) timely neurological improvement after forced cerebrospinal fluid (CSF) drainage via indwelling ventricular drain with negative pressure up to 5 cm H2O below normal reference. Demographic and SAH specific factors were extracted from the electronic medical chart and further analyzed. The level of statistically significance was set to 0.05.
Results: From 11/2010 until 05/2020 15 out of 618 (2.4%) SAH patients were diagnosed with low-pressure hydrocephalus. Low-pressure hydrocephalus was diagnosed after an average of 13.1 (± 7.7) days. A higher Evans index on the initial computer tomography (0.323 ± 0.0483 vs. 0.291 ± 0.0481; p=0.01) was the only factor associated with the occurrence of low-pressure hydrocephalus. The Evans index in patients with low-pressure hydrocephalus at the day of diagnosis rose to 0.376 ± 0.0486. Median Glasgow Coma scale after forced CSF drainage improved from 8 to 9 (p=0.02). Patients with low-pressure hydrocephalus developed a chronic hydrocephalus requiring ventricular-peritoneal shunting (VPS) more often (60.0 vs. 11.9%; p<0.0001) and stayed longer in the hospital (27.0 ± 13.2 vs. 17.1 ± 11.7 days; p=0.001).
Conclusion: Low-pressure hydrocephalus is a rare pathology in patients with SAH and should be considered especially in patients with an increase in ventricular width and normal ICP values. Since no well-known clinical parameters are associated with the occurrence of low-pressure hydrocephalus although there was a higher rate of VPS further examinations in the field of neuroinflammation and the glymphatic system should be carried out to clarify the pathophysiology.