Posttraumatic Hydrocephalus Follow-up

  • Author: Percival H Pangilinan, Jr, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Apr 22, 2015
 

Further Outpatient Care

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  • Patients or caregivers should seek immediate medical evaluation and attention if the signs and symptoms of PTH return.
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Further Inpatient Care

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  • Patients typically make rapid gains in the first 1-2 weeks following shunt placement for PTH; therefore, rehabilitation may be beneficial as PTH resolves.
  • Because shunts may malfunction, physicians should monitor patients for the signs and symptoms of PTH.
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Complications

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  • The possible complications of PTH include the following:
    • Cerebral herniation
    • Risk of aspiration as a result of dysphagia
    • Increased risk of falls
    • Inability to benefit from rehabilitation[25]
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Prognosis

Groswasser found that in patients who developed communicating hydrocephalus following a TBI, the duration of coma was longer and the incidence and severity of behavioral problems was greater.[6] Furthermore, in patients with a TBI and communicating hydrocephalus, the rate at which these individuals returned to their previous occupation was lower than it was in patients with a TBI but no PTH.

Patients typically do well after the placement of a shunt for PTH. Tribl and Oder's study indicated that the best predictor of outcome following shunting is the patient's pre-operative status. The authors' results also indicated that age at time of injury does not influence outcome.[24]

Similarly, Kim and colleagues found evidence that symptomatic improvement after pre-operative lumbar drainage provides a strong indication of the results of shunt placement and that age and sex seems to have no impact on outcome.[13]

Shunts may malfunction and require revision or replacement; therefore, careful monitoring for the signs and symptoms of functional decline is important for the physiatrist and for caretakers.

A study from Denmark indicated that in patients undergoing inpatient rehabilitation for TBI, the occurrence of PTH does not affect rehabilitation outcome or the extent of disability at discharge but does prolong the patient’s stay. The study involved 417 patients with severe TBI, with multiple regression analysis used to evaluate the effects of PTH on rehabilitation. PTH was found to increase patients’ rehabilitation stay by nearly 3 weeks.[26]

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Patient Education

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  • Patients and caregivers need to be educated about symptoms that might suggest shunt failure and should be instructed as to when medical evaluation should be sought.
  • For excellent patient education resources, visit eMedicineHealth's Brain and Nervous System Center. Also, see eMedicineHealth's patient education article Normal Pressure Hydrocephalus.
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Contributor Information and Disclosures
Author

Percival H Pangilinan, Jr, MD Associate Professor, Department of Physical Medicine and Rehabilitation, University of Michigan Health System

Percival H Pangilinan, Jr, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Coauthor(s)

Scott Strum, MD 

Scott Strum, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Brian M Kelly, DO Associate Professor, Associate Medical Director, Division of Orthotics and Prosthetics, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School; Assistant Program Director, Residency Training Program, University of Michigan Health System

Brian M Kelly, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Joseph E Hornyak, IV, MD, PhD Associate Professor, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School; Consulting Staff, Medical Director of Human Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center

Joseph E Hornyak, IV, MD, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, Association of Academic Physiatrists, American Academy of Cerebral Palsy and Developmental Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kat Kolaski, MD Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Elizabeth A Moberg-Wolff, MD Medical Director, Pediatric Rehabilitation Medicine Associates

Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References
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  2. Narayan RJ, Gokaslan ZL, Bontke CF. Neurologic sequelae of head injury. Rosenthal M, ed. Rehabilitation of the Adult and Child With Traumatic Brain Injury. 2nd ed. Philadelphia, Pa: Davis; 1990. 94-106.

  3. Stein S, Schrader P. Neurologic sequelae. Phys Med Rehabil: State Art Rev. 1990. 4:543-57.

  4. Katz RT, Brander V, Sahgal V. Updates on the diagnosis and management of posttraumatic hydrocephalus. Am J Phys Med Rehabil. 1989 Apr. 68(2):91-6. [Medline].

  5. Guyot LL, Michael DB. Post-traumatic hydrocephalus. Neurol Res. 2000 Jan. 22(1):25-8. [Medline].

  6. Groswasser Z, Cohen M, Reider-Groswasser I, et al. Incidence, CT findings and rehabilitation outcome of patients with communicative hydrocephalus following severe head injury. Brain Inj. 1988 Oct-Dec. 2(4):267-72. [Medline].

  7. Mazzini L, Campini R, Angelino E, et al. Posttraumatic hydrocephalus: a clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome. Arch Phys Med Rehabil. 2003 Nov. 84(11):1637-41. [Medline].

  8. Dandy WE, Blackfan KD. Internal hydrocephalus: an experimental, clinical, and pathological study. Am J Dis Child. 1914. 8:406:

  9. Adams RD, Victor M. Disturbances of cerebrospinal fluid and its circulation, including hydrocephalus and meningeal reactions. Principles of Neurology. 4th ed. New York, NY: McGraw-Hill Information Services Co; 1989. 623-35.

  10. Portnoy HD, Chopp M, Branch C, et al. Cerebrospinal fluid pulse waveform as an indicator of cerebral autoregulation. J Neurosurg. 1982 May. 56(5):666-78. [Medline].

  11. Kaye AH, Laws ER, eds. Brain Tumors: An Encyclopedic Approach. 2nd ed. New York, NY: Churchill Livingstone; 2001. 205.

  12. Mori K, Shimada J, Kurisaka M, et al. Classification of hydrocephalus and outcome of treatment. Brain Dev. 1995 Sep-Oct. 17(5):338-48. [Medline].

  13. Kim SW, Lee SM, Shin H. Clinical Analysis of Post-Traumatic Hydrocephalus. J Korean Neursurg Soc. 2005. 38:211-214.

  14. Long DF. Diagnosis and management of intracranial complications in traumatic brain injury rehabilitation. Horn LJ, Zasler ND, eds. Medical Rehabilitation of Traumatic Brain Injury. Philadelphia, Pa: Hanley & Belfus; 1996. 333-62.

  15. Paoletti P, Pezzotta S, Spanu G. Diagnosis and treatment of post-traumatic hydrocephalus. J Neurosurg Sci. 1983 Jul-Sep. 27(3):171-5. [Medline].

  16. Wostyn P, Audenaert K, De Deyn PP. Alzheimer's disease-related changes in diseases characterized by elevation of intracranial or intraocular pressure. Clin Neurol Neurosurg. 2008 Feb. 110(2):101-9. [Medline].

  17. Factora R, Luciano M. Normal pressure hydrocephalus: diagnosis and new approaches to treatment. Clin Geriatr Med. 2006 Aug. 22(3):645-57. [Medline].

  18. Tian HL, Xu T, Hu J, et al. Risk factors related to hydrocephalus after traumatic subarachnoid hemorrhage. Surg Neurol. 2007 Aug 16. [Medline].

  19. Kammersgaard LP, Linnemann M, Tibaek M. Hydrocephalus following severe traumatic brain injury in adults. Incidence, timing, and clinical predictors during rehabilitation. NeuroRehabilitation. 2013. 33(3):473-80. [Medline].

  20. Nasel C, Gentzsch S, Heimberger K. Diffusion-weighted magnetic resonance imaging of cerebrospinal fluid in patients with and without communicating hydrocephalus. Acta Radiol. 2007 Sep. 48(7):768-73. [Medline].

  21. Graff-Radford NR. Normal pressure hydrocephalus. Neurol Clin. 2007 Aug. 25(3):809-32, vii-viii. [Medline].

  22. Wu Y, Green NL, Wrensch MR, et al. Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery. 2007 Sep. 61(3):557-62; discussion 562-3. [Medline].

  23. Bontke CF, Zasler ND, Boake C. Rehabilitation of the head-injured patient. Narayan RK, Wilberger JE, Povlishock JT, eds. Neurotrauma. New York, NY: McGraw-Hill; 1996. 841-58.

  24. Tribl G, Oder W. Outcome after shunt implantation in severe head injury with post-traumatic hydrocephalus. Brain Inj. 2000 Apr. 14(4):345-54. [Medline].

  25. Denes Z, Barsi P, Szel I, Boros E, Fazekas G. Complication during postacute rehabilitation: patients with posttraumatic hydrocephalus. Int J Rehabil Res. 2011 Sep. 34(3):222-6. [Medline].

  26. Linnemann M, Tibaek M, Kammersgaard LP. Hydrocephalus during rehabilitation following severe TBI. Relation to recovery, outcome, and length of stay. NeuroRehabilitation. 2014. 35(4):755-61. [Medline].

 
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