Open AccessDelayed transient obstructive hydrocephalus after cerebral aneurysm rupture
Author(s) -
Yuanhong Ge,
Qingjia Lai,
Wenyu Wang,
Xuejun Xu
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000026228
Subject(s) - medicine , hydrocephalus , aneurysm , anesthesia , coma (optics) , surgery , intracranial pressure , physics , optics
Rationale: Obstructive hydrocephalus (OH) frequently occurs in patients with a ruptured cerebral aneurysm (CA), and it may lead to severe neurological deficits, including life-threatening brain herniation. OH generally occurs in the early stage of CA rupture, rather than in the late stage, and rarely resolves without therapy. Patient concerns: A 64-year-old woman with a ruptured anterior communicating artery aneurysm was treated with coil embolization. Nineteen days after her CA rupture, because of the delayed transient OH, she experienced a dramatic cycle in consciousness over 9 hours: wakefulness–drowsiness–coma–drowsiness–wakefulness. Diagnosis: The patient was diagnosed with delayed transient obstructive hydrocephalus, which is a very rare condition. Interventions: Mannitol was administered to reduce intracranial pressure. Outcomes: The patient was discharged from the hospital 30 days after admission, with a final GCS score of 15 and without weaknesses. At follow-up 2 months after discharge, brain CT revealed non-recurrence of hydrocephalus. Lessons: A blood clot of any size in the ventricle is likely to lead to obstructive hydrocephalus. Prolonged bed rest for IVH patients may help to reduce the incidence of delayed OH.