Posttraumatic Hydrocephalus Clinical Presentation
- Author: Percival H Pangilinan, Jr, MD; Chief Editor: Consuelo T Lorenzo, MD more...
Posttraumatic hydrocephalus (PTH) often has an atypical presentation and therefore may be easily missed. A high level of clinical suspicion is important for diagnosis.[14, 15]
- If acute, patients may present with coma and other focal neurologic deficits.
- If chronic, patients may demonstrate a gradual decline in functional status or may show a failure to improve. The decline in performance or functioning may be initially observed by therapists.
The cognitive decline of NPH may present similarly to dementias in elderly patients. However, Alzheimer disease more commonly presents insidiously over a period of years, with progressive memory impairment, anomia, apraxia, agnosia, and a decline in executive function. Dementia in NPH usually presents with subcortical features.
See the list below:
- A complete neurological examination should be performed and repeated as necessary to assess for changes over time.
- PTH may present as a syndrome of increased intracranial pressure with symptoms of papilledema, focal neurologic deficits, or coma.
- Most commonly, PTH presents as noncommunicating hydrocephalus with the following findings :
- Papilledema resulting from increased intracranial pressure and transmission through the subarachnoid space
- Cognitive changes, including decreased memory, decreased attention, and irritability
- NPH often presents as a classic triad of the following symptoms :
- Progressive gait disorder
- Impairment of mental function
- Urinary incontinence
- In NPH, headaches are not common and papilledema is not usually seen on funduscopic examination; patients may present with frontal release signs.
Obstructive hydrocephalus may be caused by tumors, infection, abscesses, cysts, or trauma. NPH may result from a subarachnoid hemorrhage caused by an aneurysm rupture, a TBI, or encephalopathy.
A study by Kammersgaard et al indicated that older age and low consciousness level are independent risk factors for the development of PTH during rehabilitation in patients with severe TBI. The study involved 444 patients with severe TBI, 14.2% of whom developed PTH, with 75% of the hydrocephalus cases arising during rehabilitation.
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