Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Posttraumatic Hydrocephalus Workup

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

Laboratory Studies

See the list below:

  • Urine analysis and culture - Evaluate for urinary tract infections.
  • Complete blood count (CBC) with differential - Evaluate for infection and anemia.
  • Metabolic profile - Evaluate for electrolyte abnormalities, including syndrome of inappropriate secretion of antidiuretic hormone (SIADH), cerebral salt wasting, calcium deficiency, hypoglycemia, hyperglycemia, and encephalopathy (uremic or hepatic).
  • Thyroid-stimulating hormone (TSH), free T4 - Evaluate for hypothyroidism or hyperthyroidism.
  • Arterial blood gas level - Assess oxygenation and acid/base balance.
  • Serum medication levels - Measure medication levels if toxicity suspected.
Next

Imaging Studies

See the list below:

  • Noncontrast CT scan of the brain is one of the most commonly used diagnostic modalities.
    • The progressive enlargement of the ventricular system shown on repeat computed tomography (CT) scans is the key to the diagnosis of PTH.[6]
    • CT scans may show enlarged lateral ventricles, effaced cerebral sulci, and dilation on ventricles proximal to an obstruction.[4]
    • Periventricular edema may occur in white matter, particularly around the frontal horns.[4]
    • Sulcal enlargement with ventricular enlargement suggests atrophy and hydrocephalus ex vacuo rather than hydrocephalus.[4]
    • Large cisterns and focal regions of encephalomalacia suggest atrophy.[5]
  • Magnetic resonance imaging (MRI) is another method of diagnostic evaluation.[20]
  • MRI is more useful in the evaluation of injury to structures in the posterior fossa, including cerebral aqueduct stenosis and cerebellar tonsil herniation.[21]
  • It is the neuroimaging study of choice in patients with NPH.[21]
  • MRI may be more useful than CT scanning in the identification of other neurologic disorders, especially cerebrovascular disease.[17]

Mazzini studied another imaging technique, single-photon emission CT (SPECT).[7] Mazzini found that SPECT had higher sensitivity than MRI or CT scanning in the demonstration of temporal lobe abnormality secondary to PTH.

Previous
Next

Other Tests

See the list below:

  • Radionuclide cisternography:[4]
    • Radioiodinated serum albumin (RISA) injected into the subarachnoid space by way of lumbar puncture (LP) can normally be detected in the cisterna magna, basal cisterns, and subtentorial subarachnoid space within 6 hours, with little accumulation in the ventricular system. In NPH, RISA accumulates in the ventricular system with delayed pericerebral diffusion.
    • Cisternography is usually normal in hydrocephalus ex vacuo.
  • Although debate exists, cisternography may be a useful adjunct to CT scanning of the brain.
Previous
Next

Procedures

See the list below:

  • CSF tap test
    • This test is an LP with manometry and CSF removal.
    • Imaging of the brain should be performed before initiating the LP. The risk of cerebral herniation associated with the LP is increased in patients with greatly elevated ICP.
    • The CSF tap test may be a useful predictor of the potential benefits of shunting. Kim (2005) found that symtomatic improvement after lumbar drainage has a significant role in predicting the result of shunting.
    • CSF pressure is normally 110 mm water. Shunting may help if the pressure is 135-275 mm water, and it does help if the pressure is greater than 275 mm water.
    • Cognitive and physical functions are assessed before and after the removal of 50 mL of CSF. Improvement suggests that shunting may be beneficial.
Previous
 
 
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
  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. 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].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.