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Posttraumatic Hydrocephalus Treatment & Management

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

Rehabilitation Program

Physical Therapy

The resumption of rehabilitation is usually prompt after the placement of a ventriculoperitoneal (VP) shunt.[22] Patients are typically observed for 2-3 days postoperatively. They then return to rehabilitation services to complete their brain-injury rehabilitation program. Successful shunting is usually related to more obvious and rapid improvements during rehabilitation efforts.[23]

Occupational Therapy

See Physical Therapy.

Speech Therapy

See Physical Therapy.

Recreational Therapy

See Physical Therapy.

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Surgical Intervention

See the list below:

  • Before treatment, conditions such as infection, anemia, hypoxia, seizure disorder, uremia, and encephalopathy must be ruled out or addressed. If PTH is suspected, prompt neurosurgical evaluation is highly recommended.
  • Shunting is the most common treatment for hydrocephalus. The outcome is usually favorable.
  • A shunt is usually placed from the right ventricle to the peritoneal space. The right side is normally used to avoid injury to the language centers on the left side of the brain. Shunts are usually equipped with reservoirs that are used for transiently increasing output and for testing the patency of flow.
  • Patients with acute presentations and clear signs of high-pressure hydrocephalus benefit from a shunting procedure. Patients with chronic presentations can be observed with frequent CT scanning of the brain to monitor for progression of hydrocephalus.[5]
  • In a study by Tribl and Oder, 52% of patients with PTH had significant improvement within 3 months of shunting.[24]
  • Patients with NPH also may benefit from a shunting procedure. In patients with a TBI and communicating hydrocephalus, Groswasser found that shunting promoted a recovery of consciousness and motor capacity but not a return of neurobehavioral function.[6]
  • Complications and shunt malfunctions are common.[24, 22] Complications of shunts include the following:
    • Infection - Wound infection or contamination during placement
    • Shunt failure - Displacement and leakage
    • Occlusion - Kinking and tube clotting
    • Overshunting - More fluid is shunted than necessary
    • Placement errors
  • Assessing the efficacy of surgical intervention can be problematic because of the heterogeneity of TBI severity, TBI location, nonuniform diagnostic criteria used across studies, variants of PTH, the severity of PTH, and the length of time between the occurrence of a TBI and the development of PTH. Further research is needed to control for confounding factors, elucidate criteria for surgical intervention, and assess the outcome of surgery.[15]
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Consultations

When hydrocephalus is confirmed, consultation with a neurosurgeon should be expedited.

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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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