Low-Pressure Hydrocephalus in Spontaneous Angiogram-Negative Subarachnoid Hemorrhage Following COVID-19 Infection

Weisbrod, Luke J.; Davidson, Caroline; Gard, Andrew P.; Surdell, Daniel L.

doi:10.7759/cureus.16674

Cited by 5 publications

(6 citation statements)

References 20 publications

(24 reference statements)

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“…Some specific infectious diseases have also been reported as possible etiologies for NPH, including Lyme disease, neurosyphilis and cryptococcosis [4]. There are reports of hydrocephalus following SAH in patients with concomitant coronavirus infections [5,6], but as far as we know this is the first case of NPH associated with COVID-19 infection without preceding SAH or stroke.…”

Section: Discussionmentioning

confidence: 82%

Normal pressure hydrocephalus associated with COVID-19 infection: a case report

et al. 2022

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Background COVID-19 is a pandemic disease responsible for many deaths worldwide. Many neurological manifestations have been described. We report a case of normal pressure hydrocephalus (NPH) 2 months after acute COVID19 infection, in a patient without other risk factors. Case presentation A 45-year-old male patient presented an 8-month history of progressive gait disorder and cognitive impairment after being hospitalized for SARS-CoV-2 infection. Magnetic resonance imaging (MRI) was compatible with NPH. A spinal tap test was positive and there was progressive improvement after shunting, with complete resolution of symptoms. Conclusion Other infections such as syphilis, cryptococcosis and Lyme disease have been associated with NPH. Possible mechanisms for NPH after COVID include disruption of choroid plexus cells by direct viral invasion or as a result of neuroinflammation and cytokine release and hypercoagulability leading to venous congestion and abnormalities of CSF flow. Given the significance of NPH as a cause of reversible dementia, it is important to consider the possibility of a causal association with COVID19 and understand the mechanisms behind this association.

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Section: Discussionmentioning

confidence: 82%

Normal pressure hydrocephalus associated with COVID-19 infection: a case report

et al. 2022

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“…10 Other pathophysiological mechanisms, such as a disconnection of the ventricular system from the cortical subarachnoid space as well as a decreased elasticity of the brain, have been discussed in the literature. 6,9,21,23 However, none of these theories could fully and convincingly explain the occurrence of aLPH in the systematic review by Keough et al 11 The higher rate and extension of IVH in these patients supports the theory of Rekate et al of a ventricular system isolated from the subarachnoid space. 23 At the same time, the question arises as to why the rate of aLPH was not higher in our cohort, because the rate of patients with IVH without aLPH was 71.6%.…”

Section: Discussionmentioning

confidence: 99%

“…Despite an increase in reports in recent years, the overall number of publications on this condition remains limited. [5][6][7][8][9][10] This ABBREVIATIONS aLPH = acute low-pressure hydrocephalus; CTA = CT angiography; DCI = delayed cerebral ischemia; DSA = digital subtraction angiography; EVD = external ventricular drain; GCS = Glasgow Coma Scale; ICP = intracranial pressure; ICU = intensive care unit; IQR = interquartile range; IVH = intraventricular hemorrhage; mRS = modified Rankin Scale; SAH = subarachnoid hemorrhage; TCD = transcranial Doppler ultrasonography; VPS = ventriculoperitoneal shunt; WFNS = World Federation of Neurosurgical Societies.…”

mentioning

confidence: 99%

Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage

Czorlich¹,

Schweingruber

Göttsche³

et al. 2023

Neurosurgical Focus

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OBJECTIVE Acute and chronic hydrocephalus are common pathologies after aneurysmal subarachnoid hemorrhage (SAH). Generally, the presence of acute hydrocephalus is associated with elevated intracranial pressure (ICP) treated with a ventricular drain. Subsequently, however, pronounced hydrocephalus without elevated ICP may develop in some patients with SAH in the postacute phase. This is described as acute low-pressure hydrocephalus (aLPH), and there are very limited data in the literature of this pathology. The aim of this study was to evaluate the rate of and factors associated with aLPH and describe its clinical course. METHODS In this retrospective single-center cohort study, the frequency and clinical characteristics of SAH-associated aLPH were investigated. Acute LPH was defined as an increase in ventricular size as measured by the Evans index, ICP within the normal range (< 5 mm Hg) at the time of ventricular enlargement, and timely neurological improvement after indwelling ventricular CSF drainage with negative pressure up to 5 cm H2O below normal level. Demographic and SAH-specific factors in patients with SAH treated using an external ventricular drain were extracted from the electronic medical chart and further analyzed. RESULTS From November 2010 to May 2020, 15 (3.7.%) of 406 patients with SAH fulfilled the criteria for aLPH. Acute LPH was diagnosed after an average of 13.1 ± 7.7 days. The presence of IVH and its extension were associated with the occurrence of aLPH. After undergoing the transient phase of aLPH, these patients subsequently developed a chronic, typical malresorptive hydrocephalus requiring a ventriculoperitoneal shunt more often (66.7% vs 17.4%, p < 0.001) and stayed longer in the intensive care unit (27 vs 20.5 days, p = 0.043) and in the hospital (36.4 vs 26.3 days, p = 0.004). CONCLUSIONS Acute LPH is a rare pathology in patients with SAH and negatively impacts the clinical course. It should be especially considered in patients with a lack of neurological improvement, an increase in ventricular width, and normal ICP values, so that forced CSF drainage is implemented.

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“…It is likely that the altered brain tissue permeability caused by the virus is a key factor in the transition of the high-pressure hydrocephalus after SAH to a LPH. 41…”

Section: Porous Elastic Sponge Theorymentioning

confidence: 99%

Low-/Negative-Pressure Hydrocephalus: To Understand the Formation Mechanism from the Perspective of Clinicians

Li,

Lin,

Yang

2024

J Neurol Surg A Cent Eur Neurosurg

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Low-/negative-pressure hydrocephalus (LPH/NePH) is uncommon in clinical practice, and doctors are unfamiliar with it. LPH/NePH is frequently caused by other central nervous system diseases, and patients are frequently misdiagnosed with other types of hydrocephalus, resulting in delayed treatment. LPH/NePH therapy evolved to therapeutic measures based on “external ventricular drainage below atmospheric pressure” as the number of patients with LPH/NePH described in the literature has increased. However, the mechanism of LPH/NePH formation is unknown. Thus, understanding the process of LPH/NePH development is the most important step in improving diagnosis and treatment capability. Based on case reports of LPH/NePH, we reviewed theories of transcortical pressure difference, excessive cerebral venous drainage, brain viscoelastic changes, and porous elastic sponges.

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Low-Pressure Hydrocephalus in Spontaneous Angiogram-Negative Subarachnoid Hemorrhage Following COVID-19 Infection

Cited by 5 publications

References 20 publications

Normal pressure hydrocephalus associated with COVID-19 infection: a case report

Normal pressure hydrocephalus associated with COVID-19 infection: a case report

Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage

Low-/Negative-Pressure Hydrocephalus: To Understand the Formation Mechanism from the Perspective of Clinicians

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