Incidence of surgically treated post-traumatic hydrocephalus 6 months following head injury in patients undergoing acute head computed tomography

Abstract

Background Post-traumatic hydrocephalus (PTH) is a well-known complication of head injury. The percentage of patients experiencing PTH in trauma cohorts (0.7–51.4%) varies greatly in the prior literature depending on the study population and applied diagnostic criteria. The objective was to determine the incidence of surgically treated PTH in a consecutive series of patients undergoing acute head computed tomography (CT) following injury. Methods All patients (N = 2908) with head injuries who underwent head CT and were treated at the Tampere University Hospital’s Emergency Department (August 2010–July 2012) were retrospectively evaluated from patient medical records. This study focused on adults (18 years or older) who were residents of the Pirkanmaa region at the time of injury and were clinically evaluated and scanned with head CT at the Tampere University Hospital’s emergency department within 48 h after injury (n = 1941). A thorough review of records for neurological signs and symptoms of hydrocephalus was conducted for all patients having a radiological suspicion of hydrocephalus. The diagnosis of PTH was based on clinical and radiological signs of the condition within 6 months following injury. The main outcome was surgical treatment for PTH. Clinical evidence of shunt responsiveness was required to confirm the diagnosis of PTH. Results The incidence of surgically treated PTH was 0.15% (n = 3). Incidence was 0.08% among patients with mild traumatic brain injury (TBI) and 1.1% among those with moderate to severe TBI. All the patients who developed PTH underwent neurosurgery during the initial hospitalization due to the head injury. The incidence of PTH among patients who underwent neurosurgery for acute traumatic intracranial lesions was 2.7%. Conclusion The overall incidence of surgically treated PTH was extremely low (0.15%) in our cohort. Analyses of risk factors and the evaluation of temporal profiles could not be undertaken due to the extremely small number of cases.

Posttraumatic hydrocephalus: Recent advances and new therapeutic strategies

“…It is important to note that early identification is essential for the management of TBI patients. 15 The diagnosis of PTH may be confirmed by the existence of associated signs and symptoms alongside favorable radiological investigations. A variety of criteria have been employed, including the combination of neurological symptoms like nerve deficits and headache, as well as the gradual improvement of the clinical condition over time.…”

“…Yet, following a TBI, a poor recovery or stagnation in improvement is a common indicator of PTH. It is important to note that early identification is essential for the management of TBI patients 15 . The diagnosis of PTH may be confirmed by the existence of associated signs and symptoms alongside favorable radiological investigations.…”

Prevalence of post-traumatic hydrocephalus in moderate to severe head injury

“…We read with great interest the recent article by Heinonen et al concerning the retrospective analysis of patients undergoing surgery for post-traumatic hydrocephalus (PTH) in a 2-year period, in Pirkanmaa region, Finland [3]. Out of 1941 adult patients with head injury who underwent acute head CT, only 3 (0.15%) met the clinical and radiological diagnosis of PTH and were reported to benefit from ventriculoperitoneal shunt.…”

Successful Management of Post-Traumatic Hydrocephalus and Pseudomeningocele Following Traumatic Brain Injury in a Cat

“…Usually neurologic signs, including a decreased level of consciousness, alteration in mental state, and neurological deficits (e.g., weakness, paresis/paraplegia, seizure) (1), are closely related to the injury (2). Various criteria have been suggested for PTH diagnosis; an universal criteria has not been established, even in human medicine (6,21). However, it can be confirmed by combining clinical assessment and advanced diagnostic imaging, which involves a history of TBI and identification of skull damage and enlargement of the ventricular system via computed tomography (CT) and magnetic resonance imaging (MRI) (18).…”