TY - JOUR
T1 - Acute subdural hematomas in shunted normal‑pressure hydrocephalus patients – Management options and literature review
T2 - A case‑based series
AU - Berger, Assaf
AU - Constantini, Shlomi
AU - Ram, Zvi
AU - Roth, Jonathan
N1 - Publisher Copyright:
© 2018 Surgical Neurology International | Published by Wolters Kluwer - Medknow
PY - 2018
Y1 - 2018
N2 - Background: Ventriculoperitoneal shunting (VPS) is considered a risk factor for developing subdural hematomas (SDH). Treating cases of acute SDH (aSDH) in shunted normal‑pressure hydrocephalus (NPH) patients can be challenging, and data in this field are scarce. We report our experience treating shunted NPH patients presenting with aSDH. Methods: Eight patients, aged 73 ± 6 years, with a history of VPS for NPH, hospitalized because of aSDH were included in this study. We retrospectively analyzed data regarding patients’ clinical and radiological presentation, hospitalization course, the use of antithrombotics, and response to different treatment regimens. Results: Four patients had pure aSDH, three had acute on chronic SDH, and one had subacute SDH. Patients presented with GCS 13–15 and various neurological signs, mainly confusion and unsteady gate. Two cases improved following resetting of their programmable shunt valve to its maximal pressure setting. Six cases improved after evacuation of the hematomas, five of them were operated a few days after initially resetting of the valve pressure. Three patients were discharged home, whereas five were referred to rehabilitation. Extended Glasgow Outcome Scale scores at discharge and during long‑term follow‑up were 5 and 7, respectively. Conclusions: Treatment of patients with VPS for NPH, presenting with aSDH, may differ according to the neurological status, imaging, and clinical course. Treatment options include restricting shunt function, hematoma evacuation, or both.
AB - Background: Ventriculoperitoneal shunting (VPS) is considered a risk factor for developing subdural hematomas (SDH). Treating cases of acute SDH (aSDH) in shunted normal‑pressure hydrocephalus (NPH) patients can be challenging, and data in this field are scarce. We report our experience treating shunted NPH patients presenting with aSDH. Methods: Eight patients, aged 73 ± 6 years, with a history of VPS for NPH, hospitalized because of aSDH were included in this study. We retrospectively analyzed data regarding patients’ clinical and radiological presentation, hospitalization course, the use of antithrombotics, and response to different treatment regimens. Results: Four patients had pure aSDH, three had acute on chronic SDH, and one had subacute SDH. Patients presented with GCS 13–15 and various neurological signs, mainly confusion and unsteady gate. Two cases improved following resetting of their programmable shunt valve to its maximal pressure setting. Six cases improved after evacuation of the hematomas, five of them were operated a few days after initially resetting of the valve pressure. Three patients were discharged home, whereas five were referred to rehabilitation. Extended Glasgow Outcome Scale scores at discharge and during long‑term follow‑up were 5 and 7, respectively. Conclusions: Treatment of patients with VPS for NPH, presenting with aSDH, may differ according to the neurological status, imaging, and clinical course. Treatment options include restricting shunt function, hematoma evacuation, or both.
KW - Acute subdural hematoma
KW - Hydrocephalus
KW - Shunt
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=85113947751&partnerID=8YFLogxK
U2 - 10.4103/SNI.SNI_338_18
DO - 10.4103/SNI.SNI_338_18
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AN - SCOPUS:85113947751
SN - 2152-7806
VL - 9
JO - Surgical Neurology International
JF - Surgical Neurology International
IS - 1
M1 - 238
ER -