Post-traumatic hydrocephalus in adults and paediatrics

Abstract

Post-traumatic hydrocephalus (PTH) has been given little attention over the last decades, and it still lacks a firm definition (Arch Phys Med Rehabil 98:312-319, 2016). This is due to the fact that hydrocephalus in traumatic patients has a variety of possible scenarios in terms of presenting symptoms (NeuroRehabilitation 33:473-480, 2013). It should always be considered if a patient who has suffered severe traumatic brain injury (TBI) either fails to improve, the recovery is way slower than expected, or the patient begins to deteriorate presenting one or more of the Adams-Hakim triad symptoms (incontinence, gait abnormality, and progressive dementia) (Zh Vopr Neirokhir Im N N Burdenko 75:42-46, 2011). Confusingly, these manifestations may as well be a consequence of the primary brain injury itself, which hinders proper diagnosis by deterring a physician from further investigations. On the other hand, there have been a number of reports of patients with suspicious ventriculomegaly (Evans index of >0.3) whom surprisingly were well enough clinically so as to maintain expectant management (Rinsho Shinkeigaku 50:963-965, 2010, J Neurol Sci 277:54-57, 2009). Therefore, only a combination of clinical picture, radiological evidence of hydrocephalus, and sometimes specific additional tests in dubious cases (see Sect. 11.4) should allow for establishing a diagnosis. The aim of this chapter is to review the literature and evidence-based medicine covering PTH.