Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management

Abstract

Hydrocephalus is one of the most common complications of aneurysmal subarachnoid hemorrhage (aSAH), which seriously affects the quality of life and shortens the survival time of affected patients. By reviewing the recent studies on the risk factors of aSAH-associated hydrocephalus, we aimed to explicitly present the pathogenesis of acute and chronic hydrocephalus after aSAH and make a comprehensive list of the associated risk factors of aSAH-associated hydrocephalus and shunt-dependent hydrocephalus. It would help us to better explain the occurrence of hydrocephalus after aSAH, especially hydrocephalus caused by inflammation after bleeding. Many studies have recently suggested that high mobility group box 1 may be an early upstream promoter of inflammatory response after aSAH, which also provides important ideas for us to look for potential drug treatments. The surgery, such as external ventricular drain and lumbar drainage, is the most common and effective treatment. Yet, there are often complications, such as rebleeding and intracranial infection, and the optimal timing of intervention is controversial. Besides, this is also a systematic review of the recent advances in epidemiology, pathogenesis, diagnosis, and management of aSAH-associated hydrocephalus.

Novel therapeutic modulators of astrocytes for hydrocephalus

“…In some disease models, astrocytes secrete transforming growth factor-β to reduce disease-associated inflammatory responses ( Cekanaviciute et al, 2014a , b ). However, transforming growth factor-β is closely related to subarachnoid fibrosis in the development of hydrocephalus ( Cherian et al, 2004 ; Zhan et al, 2020 ; Wang et al, 2021 ). In subarachnoid hemorrhage, the body responds to the injury by releasing various factors through many different pathways to activate astrocytes, which, in turn, repair the BBB.…”

Evaluation of deep learning frameworks coupled with an interactive user interface to predict clinical complications after aneurysmal subarachnoid hemorrhage

“…The risk of DCI is dependent on the amount of initial hemorrhage, with more blood and its breakdown products resulting in neural dysregulation, vascular dysfunction amount of initial hemorrhage, with more blood and its breakdown products resulting in neural dysregulation, vascular dysfunction, and microthrombosis through inflammation [4], [5]. Additionally, hydrocephalus (HCP) [i.e., increased cerebrospinal fluid, CSF in the ventricles, and subarachnoid spaces] contributes to EBI and may have prolonged cognitive effects among survivors [6]. The long-term outcomes in aSAH patients include functional impairment, mood fluctuations, personality changes, and emotional lability.…”

The pathogenesis of idiopathic normal pressure hydrocephalus based on the understanding of AQP1 and AQP4

“…The pathogenesis of iNPH is linked to irregular CSF circulatory dynamics based on circulation theory, inflammatory responses, osmosis abnormalities, and lymphatic drainage disorders based on penetration theory. Aquaporins (AQPs), which are responsible for CSF penetration and lymphatic outflow, are also involved in creating iNPH (Leinonen et al, 2021 ; Wang Y. et al, 2021 ).…”