A Case Study: Hyrocephalus as a Complication of Subarachnoid Hemorrhage

Abstract

Acute hydrocephalus develops within 72 hours of subarachnoid hemorrhage. As many as 25% of patients die from this complication of subarachnoid hemorrhage (SAH). Intracranial blood vessel rupture causes blood to accumulate in the subarachnoid causing cerebrospinal fluid obstruction or hydrocephalus. A 65-years-old woman came with complaints of decreased consciousness since 4 hours before hospital admission, which was preceded by severe headache, neck tension, and vomiting. She had a history of uncontrolled hypertension. She had no history of head trauma or drug usage. Physical examination found her Glasgow Coma Scale score on admission was 12, hypertensive grade I, and neurologic examination revealed nuchal rigidity. CT scans showed subarachnoid hemorrhage in cisterna basal extending to bilateral fissure sylvii, parietal sinistra region, and bilateral occipital region with cerebral edema and hydrocephalus. Management was ABC control, head position 300, oxygen, mannitol, citicolin, tranexamic acid, glaucon, nimodipine, perdipine, and external ventricular drainage (EVD). After 10 days, an EVD clamp test was performed, found to be independent of the shunt, and EVD removal was performed in day 13. External ventricular drainage is the key to managing of subarachnoid hemorrhage with hydrocephalus