eMedicine Specialties > Physical Medicine and Rehabilitation > Traumatic Brain Injury

Posttraumatic Hydrocephalus: Follow-up

Author: Percival H Pangilinan Jr, MD, Clinical Instructor and Consulting Staff, Department of Physical Medicine and Rehabilitation, University of Michigan Health System.
Coauthor(s): Brian M Kelly, DO, Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School; Assistant Program Director, Residency Training Program, Consulting Staff, Service Chief 6A, Inpatient Rehabilitation Services, University of Michigan Health System; Joseph E Hornyak IV, MD, PhD, Assistant 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; Scott Strum, MD, Director of Traumatic Brain Injury Service, Assistant Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center
Contributor Information and Disclosures

Updated: Feb 12, 2008

Follow-up

Further Inpatient Care

  • 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.

Further Outpatient Care

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

Complications

  • 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

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.23
  • 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.

Patient Education

  • 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 eMedicine's Dementia Center. Also, see eMedicine's patient education article Normal Pressure Hydrocephalus.

Miscellaneous

Medicolegal Pitfalls

  • The main medicolegal risks are a failure to recognize the problem and to arrange for a neurosurgical assessment.
  • An awareness that hydrocephalus occurs in patients with a TBI and that it occurs with signs and symptoms that are common to numerous other TBI complications should result in a low threshold for performing CT scanning when hydrocephalus is suspected.
 


More on Posttraumatic Hydrocephalus

Overview: Posttraumatic Hydrocephalus
Differential Diagnoses & Workup: Posttraumatic Hydrocephalus
Treatment & Medication: Posttraumatic Hydrocephalus
Follow-up: Posttraumatic Hydrocephalus
References
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References

  1. Bontke CF. Medical complications related to traumatic brain injury. Phys Med Rehabil: State Art Rev. 1989;3:43-58.

  2. Narayan RJ, Gokaslan ZL, Bontke CF. Neurologic sequelae of head injury. In: 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. Apr 1989;68(2):91-6. [Medline].

  5. Guyot LL, Michael DB. Post-traumatic hydrocephalus. Neurol Res. Jan 2000;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. Oct-Dec 1988;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. Nov 2003;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. In: 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. May 1982;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. Sep-Oct 1995;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. In: 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. Jul-Sep 1983;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. Feb 2008;110(2):101-9. [Medline].

  17. Factora R, Luciano M. Normal pressure hydrocephalus: diagnosis and new approaches to treatment. Clin Geriatr Med. Aug 2006;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. Aug 16 2007;[Medline].

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

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

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

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

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

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Further Reading

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Keywords

posttraumatic hydrocephalus, PTH, hydrocephalus, traumatic brain injury, TBI, head injury, noncommunicating hydrocephalus, obstructive hydrocephalus, communicating hydrocephalus, nonobstructive hydrocephalus, normal pressure hydrocephalus, NPH

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Contributor Information and Disclosures

Author

Percival H Pangilinan Jr, MD, Clinical Instructor and Consulting Staff, 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 and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Coauthor(s)

Brian M Kelly, DO, Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School; Assistant Program Director, Residency Training Program, Consulting Staff, Service Chief 6A, Inpatient Rehabilitation Services, 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, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Joseph E Hornyak IV, MD, PhD, Assistant 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 Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Scott Strum, MD, Director of Traumatic Brain Injury Service, Assistant Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center
Scott Strum, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Medical Editor

Elizabeth A Moberg-Wolff, MD, Associate Professor and Pediatric PM&R Fellowship Director, Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin; Program Director, Tone Management and Mobility, Department of Physical Medicine and Rehabilitation, Children's Hospital of Wisconsin
Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy of Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation
Disclosure: Medtronic Neurological Grant/research funds Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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 and American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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