Posttraumatic Hydrocephalus Follow-up

Updated: Feb 03, 2021
  • Author: John J Danko, DO, FAAPMR; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Follow-up

Further Outpatient Care

Routine follow-up with the patient's primary care physician, neurosurgeon, and rehabilitation specialist, as well as with skilled therapists, is crucial to continued community reintegration and maximization of patient outcomes. Patients or caregivers should seek immediate medical evaluation and attention if the signs and symptoms of posttraumatic hydrocephalus (PTH) return.

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Further Inpatient Care

Patients typically make rapid gains in the first 1-2 weeks following shunt placement for PTH; therefore, inpatient 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

The possible complications of PTH include the following:

  • Cerebral herniation
  • Risk of aspiration as a result of dysphagia
  • Increased risk of falls
  • Cognitive decline
  • Loss of independence
  • Inability to benefit from rehabilitation [34]
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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. [7] 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. [33]

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. [15]

Shunts may malfunction and require revision or replacement; [35] 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. [36]

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Patient Education

See the list below:

  • 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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