Transient Obstructive Hydrocephalus Associated with Cerebrospinal Fluid Dynamic: An Unusual Case of Early Neurological Deterioration in Intracerebral Hemorrhage Patient

Sen Yang, Rongkang Mai, Weizhao Gong and Yong Zheng*

Department of Neurosurgery, The Second Affiliated Hospital of Shenzhen University (People's Hospital of Shenzhen Baoan District), China

^*Correspondance to: Yong Zheng 

 PDF  Full Text Case Report | Open Access

Abstract:

Spontaneous Intra Cerebral Hemorrhage (ICH) is a subtype of stroke and has a high mortality and disability rate. Early Neurological Deterioration (END) is a common complication of ICH, that refers to the rapid deterioration of the disease in the early stages and is related to poor longterm prognosis. There are widely used rating scales and a large number of studies that analyze risk factors in order to identify those at the highest risk and measures to response. However, rare END caused by special mechanic cannot be predicted using routine clinical evaluations. We describe an old patient presented a sudden END, characterized by projectile vomiting and rapidly deteriorating state of consciousness 60 hours post-onset of ICH, who was initially classified as low risk during routine clinical evaluation. Through a detailed review of imaging data, a shrunk blood clot was found lodged in the midbrain aqueduct driven by Cerebro Spinal Fluid (CSF) circulation, causing acute obstructive hydrocephalus, and conservative treatments were administered after a thorough discussion of the underlying mechanism. The patient's consciousness gradually returned to awake within 48 hours when the blood clot got through the stenosis aided by the elevated pressure of CSF dynamic in turn of hydrocephalus. Follow-up results confirmed that this case of END, which manifested as transient obstructive hydrocephalus, had no effect on long-term prognosis, and this rare CSF dynamic factor has not been previously considered in predictive models for END and can't be overlooked.

Keywords:

Intracerebral hemorrhage; Intraventricular hemorrhage; Obstructive hydrocephalus; Cerebrospinal fluid dynamic; Early neurological deterioration

Cite the Article:

Yang S, Mai R, Gong W, Zheng Y. Transient Obstructive Hydrocephalus Associated with Cerebrospinal Fluid Dynamic: An Unusual Case of Early Neurological Deterioration in Intracerebral Hemorrhage Patient. Clin Case Rep Int. 2024; 8: 1711..