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Minim Invasive Neurosurg 2003; 46(6): 344-348
DOI: 10.1055/s-2003-812500
Original Article
© Georg Thieme Verlag Stuttgart · New York

Factors Leading to Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage

B.  T.  Demirgil1 , B.  Tugcu1 , L.  Postalci1 , G.  Guclu1 , A.  Dalgic1 , Z.  Oral1
  • 1Bakirkoy Psychiatric and Neurological Diseases Hospital, 2nd Neurosurgery Clinic, Istanbul, Turkey
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Publication History

Publication Date:
17 February 2004 (online)

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Abstract

Hydrocephalus is not a rare complication following aneurysmal subarachnoid hemorrhage. Hydrocephalus following subarachnoid hemorrhage can progress acutely (0 - 3 days), subacutely (4 - 13 days) or chronically (after 13 days). The predisposing factors leading to hydrocephalus after subarachnoid hemorrhage are not known exactly. This study assessed the predictive factors for the development of this condition. All patients presenting with subarachnoid hemorrhage between 1992 - 2001 were evaluated. All of them had initial computed tomography (CT) and hydrocephalus was diagnosed on CT scans. Age, gender, preexisting diabetes mellitus and hypertension, neurological state according to the Hunt and Hess scale at admission, Fischer grade on CT, the presence of intraventricular hemorrhage and localization of aneurysm were analyzed to see if there was any meanful relationship between hydrocephalus and these factors.

One hundred and fourteen patients with aneurysmal subarachnoid hemorrhage were evaluated. The incidence of hydrocephalus was 28.1 %. The incidence for acute hydrocephalus was 18.4 %, for subacute 5.2 % and for chronic 4.3 %. Sixty-nine percent of patients with hydrocephalus were graded as 3, 4 or 5 according to the Hunt and Hess scale on admission. Fifty-five percent of patients with hydrocephalus were graded as 3 and 4 according to Fisher grade on initial CT scan. Preexisting diabetes, higher Fisher grade and intraventricular hemorrhage were statistically significant predictors for the development of hydrocephalus. But only preexisting diabetes and higher Fisher grade were independent predictors according to multivariate analyses.

Key words

Subarachnoid hemorrhage - aneurysm and hydrocephalus

References

  • 1 Graff-Radford N R, Torner J, Adams H P, Kassell N F. Factors associated with hydrocephalus in subarachnoid hemorrhage. A report of the Cooperative Aneurysma Study.  Arch Neurol. 1989;  33 286-291
    PubMedSearch in Google Scholar
  • 2 Milhorat T. Acute hydrocephalus after aneurysmal subarachnoid hemorrhage.  Neurosurgery. 1987;  20 15-20
    PubMedSearch in Google Scholar
  • 3 Vale F L, Bradley E L, Fisher W S. The relationship of subarachnoid hemorrhage and the need for postoperative shunting.  J Neurosurg. 1997;  86 462-466
    CrossrefPubMedSearch in Google Scholar
  • 4 Sheehan J P, Polin R S, Sheehan J M, Baskaya M K, Kassell N F. and Participants . Factors associated with hydrocephalus after aneurysmal subarachnoid hemorrhage.  Neurosurgery. 1999;  45 1120-1128
    CrossrefPubMedSearch in Google Scholar
  • 5 Vassloutis J, Richardson A E. Ventricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage.  J Neurosurg. 1979;  51 341-351
    CrossrefPubMedSearch in Google Scholar
  • 6 Durai Z, Hynan L S, Kopitnik T A, Samson D. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage.  Neurosurgery. 2003;  52 763-771
    PubMedSearch in Google Scholar
  • 7 Kassell N F, Torner J C, Haley E C, June J A, Adams H P, Kongable G. The International Cooperative Study on the Timing of Aneurysmal Surgery Part I - overall management results.  J Neurosurgery. 1990;  73 18-36
    CrossrefPubMedSearch in Google Scholar
  • 8 Kassell N F, Torner J C, Haley E C, June J A, Adams H P. The International Cooperative Study on the Timing of Aneurysmal Surgery Part II - Surgical results.  J Neurosurg. 1990;  73 37-47
    CrossrefPubMedSearch in Google Scholar
  • 9 Black P M, Tzouras A, Foley L. Cerebrospinal fluid dynamics and hydrocephalus after experimental subarachnoid hemorrhage.  Neurosurgery. 1985;  17 57-62
    PubMedSearch in Google Scholar
  • 10 Hasan D, Tanghe H L. Distribution of cisternal blood in patients with acute hydrocephalus after subarachnoid hemorrhage.  Ann Neurol. 1992;  31 374-378
    CrossrefPubMedSearch in Google Scholar
  • 11 Kostaljanetz M. CSF dynamics in patients with subarachnoid and/or intraventricular hemorrhage.  J Neurosurg. 1984;  60 940-946
    PubMedSearch in Google Scholar
  • 12 Massicotte E M, Bigio M R Del. Human arachnoid villi response to subarachnoid hemorrhage: possibile relationship to chronic hydrocephalus.  J Neurosurg. 1999;  91 80-84
    PubMedSearch in Google Scholar
  • 13 Sajanti J, Heikkinen M, Majamaa K. Transient increase in procollagen propeptide in the CSF after subarachnoid hemorrhage.  Neurology. 2000;  55 359-363
    PubMedSearch in Google Scholar
  • 14 Black P M. Hydrocephalus and vasospasm after subarachnoid hemorrhage from ruptured intracranial aneurysm.  Neurosurgery. 1986;  18 12-16
    CrossrefPubMedSearch in Google Scholar
  • 15 Heros R C. Acute hydrocephalus after subarachnoid hemorrhage.  Stroke. 1989;  20 715-717
    CrossrefPubMedSearch in Google Scholar
  • 16 Pinsker M O, Gerstner W, Wolf S, Trost H A, Lumenta C B. Surgery and outcome for aneurysmal subarachnoid hemorrhage in elderly patients.  Acta Neurochir Suppl. 2002;  82 61-64
    PubMedSearch in Google Scholar
  • 17 Hasan D, Vermeulen M, Wijdicks E FM. et al . Management problems in acute hydrocephalus after subarachnoid hemorrhage.  Stroke. 1989;  20 747-753
    CrossrefPubMedSearch in Google Scholar
  • 18 Mehta V, Holness R O, Connelly K, Walling S, Hall R. Acute hydrocephalus following aneurysmal subarachnoid hemorrhage.  Can J Neurol Sci. 1996;  23 40-45
    CrossrefPubMedSearch in Google Scholar
  • 19 Suarez-Rivera O. Acute hydrocephalus after subarachnoid hemorrhage.  Surg Neurol. 1998;  49 563-565
    CrossrefPubMedSearch in Google Scholar
  • 20 Vermeij F H, Hasan D, Vermeulen M, Tanghe H LJ, Gijn J van. Predictive factors for deterioration from hydrocephalus after subarrachnoid hemorrhage.  Neurology. 1994;  44 1851-1855
    CrossrefPubMedSearch in Google Scholar
  • 21 Tomasello F, d'Avella D, Divitiis O de. Does lamina terminalis fenestration reduce the incidence of chronic hydrocephalus after subarachnoid hemorrhage?.  Neurosurgery. 1999;  45 827-832
    PubMedSearch in Google Scholar
  • 22 Yoshioka H, Inagawa T, Tokuda Y, Inokuchi F. Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage.  Surg Neurol. 2000;  53 119-124
    CrossrefPubMedSearch in Google Scholar
  • 23 Lino K, Yoshinari M, Yoshizumi H, Ichikawa K, Iwase M, Fujishima M. Normal pressure hydrocephalus in diabetic patients with recurrent episodes of hypoglisemic coma.  Diabetes Res Clin Pract. 2000;  47 105-110
    CrossrefPubMedSearch in Google Scholar
  • 24 Krauss J K, Regel J P, Vach W, Droste D W, Borremans J J, Mergner T. Vascular risk factors and arteriosclerotic disease in idiopathic normal-pressure hydrocephalus of the elderly.  Stroke. 1996;  27 24-29
    PubMedSearch in Google Scholar
  • 25 Sethi H, Moore A, Dervin J, Clifton A, MacSweeney J E. Hydrocephalus: comparison of clipping and embolization in aneurysm treatment.  J Neurosurg. 2000;  92 991-994
    PubMedSearch in Google Scholar
  • 26 Auer L M, Mokry M. Disturbed cerebrospinal fluid circulation after subarachnoid hemorrhage acute aneurysm surgery.  Neurosurgery. 1990;  26 804-809
    CrossrefPubMedSearch in Google Scholar
  • 27 Gruber A, Reinprecht A, Bavinzski G, Czeck T, Richling B. Chronic shunt-dependent hydrocephalus after early surgical and early endovascular treatment of ruptured intracranial aneurysm.  Neurosurgery. 1999;  44 503-512
    CrossrefPubMedSearch in Google Scholar

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