Acute hydrocephalus in posterior fossa injury

Abstract

This is the first known report of the use of computerized tomography (CT) scanning to examine acute hydrocephalus in posterior fossa injury. Of the 1802 patients with acute head trauma treated at Funabashi Municipal Medical Center, 53 (2.9%) had suffered injury to the posterior fossa. Of these, 12 patients (22.6%) had associated acute hydrocephalus: nine patients with acute epidural hematoma (AEH) and three with intracerebellar hematoma and contusion (IH/C). There was a significant relationship between cases of AEH with hydrocephalus and supratentorial extension, hematoma thickness of 15 mm or more, and abnormal mesencephalic cisterns. In cases of IH/C, bilateral lesions and no visible fourth ventricle were significant causes of hydrocephalus. According to these results, possible mechanisms of acute hydrocephalus in posterior fossa injury may be as follow: in cases of AEH, hematoma that extends to the supratentorial area compresses the aqueduct posteriorly and causes hydrocephalus; in cases of IH/C, hematoma and contusional lesions may directly occlude the fourth ventricle and cause acute hydrocephalus. Seven patients suffering from AEH with acute hydrocephalus underwent evacuation of their hematoma without external ventricular drainage. In these cases, CT scanning showed that the hydrocephalus improved immediately after evacuation of the hematoma. Two patients suffering from IH/C with hydrocephalus underwent a procedure for evacuation of the hematoma and external ventricular drainage. The authors do not believe that ventricular drainage is necessary in treating posterior fossa AEH. However, both evacuation of the hematoma and ventricular drainage are necessary in cases of IH/C with hydrocephalus to provide the patient with every chance for survival. There was no significant difference in mortality rates when cases of AEH with acute hydrocephalus (0%) were compared with cases of AEH without hydrocephalus (7.7%). The observed mortality rates in cases of IH/C with hydrocephalus and those without hydrocephalus were 100% and 15.4%, respectively; this is statistically significant.

An atypical case of head trauma with late onset of contrecoup epidural hematoma, cerebellar contusion, and cerebral infarction in the territory of the recurrent artery of Heubner

“…[4][5][6]8,10,13,19,21,25 The prognostic factors for cerebellar contusion have been reported to be Glasgow Coma Scale (GCS) score at admission and concomitant presence of supratentorial lesions. 4 Most of the concomitant supratentorial lesions were contralateral acute subdural hematoma and cerebral contusion.…”

Traumatic posterior fossa subdural hematomas

“…To the best of our knowledge, only 55 cases of posterior fossa SDHs have been reported. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Herein, we report an additional 10 cases of posterior fossa SDHs and review their characteristics.…”

Depressed Fracture Involving the Posterior Fossa in a Child

“…[1][2][3][4] A 4-year-old female child presented 8 hours after with the history of fall while playing from 4' height at home on her back. She had loss of consciousness for 1 hour and multiple episodes of vomiting.…”

“…6 Most of the patients with posterior fossa depressed fractures can be managed conservatively. 4 The indications for neurosurgical intervention are neurological deficit (s) due to mass effect and compression of the underlying neural structures, compound injuries or cosmetic deformity. 6 Usually in neurologically well preserved and uncomplicated cases the outcome is excellent, 1,4 however significant compression of the brainstem structures is associated with poorer outcome.…”