Hydrocephalus after aneurysmal subarachnoid hemorrhage diagnosis [Neurosurgery Wiki]

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====== Hydrocephalus after aneurysmal subarachnoid hemorrhage diagnosis ======

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[[Hydrocephalus after aneurysmal subarachnoid hemorrhage]] diagnosis is based on clinical assessment and neuroimaging findings.

1. Clinical Signs and Symptoms
Acute Hydrocephalus (first 72 hours)

Decreased level of consciousness
Headache, nausea, vomiting
Pupillary abnormalities
Impaired upward gaze (sunset sign)
Altered brainstem reflexes
Hypertension and bradycardia (Cushing’s response)
Subacute/Chronic Hydrocephalus (beyond 7–14 days)

Progressive cognitive decline (confusion, memory deficits)
Gait disturbances (wide-based gait, shuffling steps)
Urinary incontinence
Features resembling normal pressure hydrocephalus (NPH) in some cases
2. Imaging Findings
Non-contrast CT Scan (Initial Diagnostic Test)

Enlargement of the lateral and third ventricles
Effacement of cortical sulci (suggesting CSF outflow obstruction)
Periventricular hypoattenuation (suggesting transependymal CSF flow)
Fisher grade of SAH severity may predict hydrocephalus risk
CT or MR Ventriculography (For Shunt Planning)

Can assess CSF flow dynamics in chronic cases
MRI Brain with CSF Flow Studies

Helps evaluate communicating vs. non-communicating hydrocephalus
Cine phase-contrast MRI may show decreased CSF flow at the aqueduct
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[[Hydrocephalus after aneurysmal subarachnoid hemorrhage]] early [[recognition]] of its signs and symptoms and accurate interpretation of computed tomography (CT) studies are important for the management of patients with SAH. Clinically, a poor neurologic grade has the highest correlation with an increased incidence of hydrocephalus. Radiographically, the bicaudate index on CT studies has emerged as the best marker of this condition. Although further studies are needed to understand the complex pathophysiology of this condition, hydrocephalus after SAH can be treated effectively using current technology
((Germanwala AV, Huang J, Tamargo RJ. Hydrocephalus after aneurysmal
subarachnoid hemorrhage. Neurosurg Clin N Am. 2010 Apr;21(2):263-70. doi:
10.1016/j.nec.2009.10.013. Review. PubMed PMID: 20380968.
)).
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Most readmissions after [[aneurysmal subarachnoid hemorrhage]] (SAH) relate to late consequences of hemorrhage, such as hydrocephalus, or medical complications secondary to severe neurological injury. Although a minority of readmissions may potentially be avoided with closer medical follow-up in the transitional care environment, readmission after SAH is an insensitive and likely inappropriate hospital performance metric
((Greenberg JK, Washington CW, Guniganti R, Dacey RG Jr, Derdeyn CP, Zipfel GJ. 
Causes of 30-day readmission after aneurysmal subarachnoid hemorrhage. J
Neurosurg. 2016 Mar;124(3):743-9. doi: 10.3171/2015.2.JNS142771. Epub 2015 Sep
11. PubMed PMID: 26361278.
)).

Data demonstrate that gender influences acute hydrocephalus development in a rat SAH model. Future studies should determine the role of [[estrogen]] in SAH-induced hydrocephalus
((Shishido H, Zhang H, Okubo S, Hua Y, Keep RF, Xi G. The Effect of Gender on
Acute Hydrocephalus after Experimental Subarachnoid Hemorrhage. Acta Neurochir
Suppl. 2016;121:335-9. doi: 10.1007/978-3-319-18497-5_58. PubMed PMID: 26463971.
)).

Hydrocephalus might cause gradual obtundation in the first few hours or days; it can be treated by lumbar puncture or ventricular drainage, dependent on the site of obstruction 

Aneurysmal [[subarachnoid hemorrhage]] (SAH) has been reported to induce an intrathecal inflammatory reaction reflected by cytokine release, particularly interleukin-6 (IL-6), which correlates with early brain damage and poor outcome.