Acute post-traumatic hydrocephalus in children due to aqueductal obstruction by blood clot: a series of 6 patients.

Abstract

INTRODUCTION:

Post-traumatic hydrocephalus following head injury is a well-known entity. Most cases occur in patients with severe head injuries, often following decompressive craniectomy. On the contrary, acute post-traumatic hydrocephalus, caused by aqueductal obstruction by a blood clot, following mild head injury is uncommon.

CLINICAL MATERIAL:

Six patients aged between 6 and 15 months presented hydrocephalus secondary to a blood clot in the aqueduct. Because of intracranial hypertension at presentation, 4 patients were urgently treated with external ventricular drains (EVDs). Post-operative course was uneventful. In 2 cases, EVDs were removed without further treatments. In 2 cases, hydrocephalus recurred. These patients were successfully treated with endoscopic third ventriculostomy. The remaining two patients developed symptoms a few days after the trauma. One, that presented hydrocephalus at imaging, was managed with a ventriculo-peritoneal shunt; the other, that presented subdural hygroma, was managed with subduro-peritoneal shunt that was removed later. All patients had complete recovery.

DISCUSSION AND CONCLUSION:

Hydrocephalus secondary to clot in the aqueduct may rarely be the result of mild head injury in young children. Usually, prompt surgical management warrants a very good outcome. Most children may be treated without a permanent shunt, by using external drains and endoscopic third ventriculostomy.

• Authors: Pietro Spennato, Claudio Ruggiero, Raffaele Stefano Parlato, Vincenzo Trischitta, Giuseppe Mirone, Maria Serena De Santi, Giuseppe Cinalli
• Journal: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (Childs Nerv Syst) Vol. 35 Issue 11 Pg. 2037-2041 (11 2019) ISSN: 1433-0350 [Electronic] Germany
• PMID: 31346735 (Publication Type: Journal Article)

Topics

• Accidental Falls
• Cerebral Aqueduct (diagnostic imaging)
• Cerebral Hemorrhage, Traumatic (complications, diagnostic imaging)
• Cerebral Intraventricular Hemorrhage (complications, diagnostic imaging)
• Drainage
• Female
• Humans
• Hydrocephalus (diagnostic imaging, etiology, surgery)
• Infant
• Intracranial Thrombosis (complications, diagnostic imaging)
• Magnetic Resonance Imaging
• Male
• Neurosurgical Procedures
• Subdural Effusion (diagnostic imaging, etiology, surgery)
• Ventriculoperitoneal Shunt
• Ventriculostomy