Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage

Yoshioka, Hiroyuki; Inagawa, Tetsuji; Tokuda, Yuji; Inokuchi, Futoshi

doi:10.1016/s0090-3019(99)00185-8

Cited by 90 publications

(56 citation statements)

References 42 publications

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“…13,50 By using the same radiological criteria described by Ferch et al, 13 the incidence of hydrocephalus in our series reached a similar value of 53.2%. Several hypotheses have been proposed to explain this higher rate: 1) an atrophy-related larger subarachnoid space may result, after a large accumulation of blood, in increased arachnoid granulation change; 2) constitutional ventricular size makes patients more susceptible to hydrocephalus; and 3) CSF circulation time is prolonged due to a reduction of secretion resulting in CSF stagnation.…”

Section: Neurological Deterioration and Outcomesupporting

confidence: 82%

Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients

Proust¹,

Gérardin

Derrey³

et al. 2010

JNS

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Object The aim of the study was to assess postprocedural neurological deterioration and outcome in patients older than 70 years of age in whom treatment was managed in an interdisciplinary context. Methods This prospective longitudinal study included all patients 70 years of age or older treated for ruptured cerebral aneurysm over 10 years (June 1997–June 2007). The population was composed of 64 patients. The neurovascular interdisciplinary team jointly discussed the early obliteration procedure for each aneurysm. Neurological deterioration during the postprocedural 2 months and outcome at 6 months were assessed during consultation according to the modified Rankin Scale (mRS) as follows: favorable (mRS score ≤ 2) and unfavorable (mRS score > 2). Results Aneurysm sac obliteration was performed by microvascular clipping in 34 patients (53.1%) and by endovascular coiling in 30 (46.9%). Postprocedural neurological deterioration occurred in 30 patients (46.9%), related to ischemia in 19 (29.7%), rebleeding in 1 (1.6%), and hydrocephalus in 10 (15.6%). At 6 months, the outcome was favorable in 39 patients (60.9%). By multivariate regression logistic analysis, the independent factors associated with unfavorable outcome were age exceeding 75 years (p = 0.005), poor initial grade (p < 0.0001), and the occurrence of ischemia (p < 0.0001). Conclusions The baseline characteristics of SAH in the elderly were only slightly different from those in younger patients. In the elderly, the interdisciplinary approach may be considered useful to decrease the ischemic consequences.

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Section: Neurological Deterioration and Outcomesupporting

confidence: 82%

Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients

Proust¹,

Gérardin

Derrey³

et al. 2010

JNS

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“…3,17,23 Previous studies have shown advanced age to be an independent risk factor for SDHCP after aSAH. 3,12,21,25,33 Our analysis demonstrated increased age to be associated with a higher risk of receiving a shunt after aSAH. van Gijn et al 9 have demonstrated a quantitative correlation between increasing age and higher bicaudate indices; therefore, it could be that hydrocephalus is diagnosed more frequently with increasing age.…”

Section: Discussionmentioning

confidence: 64%

“…3,4,14,15,25 In addition, it is the most common cause of readmission after aSAH. 13 CSF shunting is prone to short-and long-term complications, including life-threatening obstructions and infections.…”

Section: Discussionmentioning

confidence: 99%

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Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage

Adams

Ban

Leinonen

et al. 2016

Stroke

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A cute aneurysmal subarachnoid hemorrhage (aSAH) is a critical systemic condition, and survivors of the primary bleed require multidisciplinary neurointensive care. 1 People who survive aSAH carry an increased risk for various complications including epilepsy, depression, cognitive impairment, shunt requirement for hydrocephalus, and shunt complications. 1Hydrocephalus after aSAH has been reported to occur in 6% to 67% of the cases.2-6 The acute phase can be self-limiting in some patients, whereas others will require external ventricular drainage (EVD) to alleviate hydrocephalus symptoms. 7Whereas mechanisms of hydrocephalus development have not been fully elucidated, studies have suggested deterioration of the cerebrospinal fluid (CSF) dynamics, 3,8 obstructive mechanisms because of blood products, 3,9 disrupted absorption at the arachnoid granulations level, 3,10 or inflammation 11 as possible causes. For some patients, this will continue to develop into a chronic condition requiring permanent CSF diversion, Background and Purpose-Shunt dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequela that may lead to poor neurological outcome and predisposes to various interventions, admissions, and complications. We reviewed post-aSAH shunt dependency in a population-based sample and tested the feasibility of a clinical risk score to identify subgroups of aSAH patients with increasing risk of shunting for hydrocephalus. Methods-A total of 1533 aSAH patients from the population-based Eastern Finland Saccular Intracranial Aneurysm Database (Kuopio, Finland) were used in a recursive partitioning analysis to identify risk factors for shunting after aSAH. The risk model was built and internally validated in random split cohorts. External validation was conducted on 946 aSAH patients from the Southwestern Tertiary Aneurysm Registry (Dallas, TX) and tested using receiver-operating characteristic curves. Results-Of all patients alive ≥14 days, 17.7% required permanent cerebrospinal fluid diversion. The recursive partitioning analysis defined 6 groups with successively increased risk for shunting. These groups also successively risk stratified functional outcome at 12 months, shunt complications, and time-to-shunt rates. The area under the curve-receiveroperating characteristic curve for the exploratory sample and internal validation sample was 0.82 and 0.78, respectively, with an external validation of 0.68. Conclusions-Shunt dependency after aSAH is associated with higher morbidity and mortality, and prediction modeling of shunt dependency is feasible with clinically useful yields. It is important to identify and understand the factors that increase risk for shunting and to eliminate or mitigate the reversible factors. The aSAH-PARAS Consortium (Aneurysmal Subarachnoid Hemorrhage Patients' Risk Assessment for Shunting) has been initiated to pool the collective insights and resources to address key questions in post-aSAH shunt dependency to inform future aSAH treatment guidelines. The onlin...

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“…Some authors have reported that the extent of meningeal fibrosis can increase in older patients, which impairs CSF circulation and decreases CSF absorption 40 . Moreover, the wider subarachnoid space in older patients can contain larger volumes of subarachnoid blood after TBI; thus, increasing their risks for developing a CSF circulation disturbance 41 . Injury severity is another impact factor for hydrocephalus.…”

Section: Mechanisms Of Hydrocephalus After DCmentioning

confidence: 99%

The influence of decompressive craniectomy on the development of hydrocephalus: a review

Ding

Guo

Huang

2014

Arq. Neuro-Psiquiatr.

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Decompressive craniectomy (DC) is widely used to treat intracranial hypertension following traumatic brain injury (TBI) or cerebral vascular disease. Many studies have discussed complications of this procedure, and hydrocephalus is a common complication of DC. To further evaluate the relationship between DC and hydrocephalus, a review of the literature was performed. Numerous complications may arise after DC, including contusion or hematoma expansion, epilepsy, herniation of the cortex through a bone defect, CSF leakage through the scalp incision, infection, subdural effusion, hydrocephalus and "syndrome of the trephined". Several hydrocephalus predictors were identified; these included DC, distance from the midline, hygroma, age, injury severity, subarachnoid or intraventricular hemorrhage, delayed time to craniotomy, repeated operation, and duraplasity. However, results differed among studies. The impact of DC on hydrocephalus remains controversial.Keywords: traumatic brain injury, hydrocephalus, decompressive craniectomy. RESUMOA craniectomia descompressiva (CD) é amplamente utilizada para tratar a hipertensão intracraniana após trauma craniencefálico (TC) ou doença cerebrovascular. Vários estudos discutem as complicações deste procedimento, sendo a hidrocefalia uma das complicações mais frequentes. Fizemos uma revisão da literatura para avaliar a relação entre a CD e a hidrocefalia. Podem ocorrer numerosas complicações após a CD, incluindo aumento de volume por contusão ou hematoma, epilepsia e herniação do cortex cerebral através do acesso ósseo. Fístulas liquóricas através a incisão no couro cabeludo, infecções, hematomas subdurais, hidrocefalia e a "síndrome pós-trepanação". Foram identificados vários fatores preditivos de hidrocefalia: a distância da CD em relação à linha média, a ocorrência de higroma, a idade, a gravidade da lesão, a hemorragia subaracnóidea ou intraventricular, o tempo decorrido até a craniectomia, as reoperações e o uso de plástica com dura-máter. Entretanto, há divergências entre os autores e o impacto da CD na hidrocefalia continua controvertido.Palavras-chave: trauma cranencefálico, hidrocefalia, craniectomia descompressiva.

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Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage

Cited by 90 publications

References 42 publications

Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients

Interdisciplinary treatment of ruptured cerebral aneurysms in elderly patients

Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage

The influence of decompressive craniectomy on the development of hydrocephalus: a review

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