Posttraumatic hydrocephalus: A clinical, neuroradiologic, and neuropsychologic assessment of long-term outcome

Objectives: To detect the clinical and radiologic characteristics of posttraumatic hydrocephalus (PTH), to define its prognostic value, and to assess the effects of shunt surgery. Design: Correlational study on a prospective cohort. Setting: Brain injury rehabilitation center. Participants: One hundred forty patients with severe traumatic brain injury (TBI) referred to an inpatient intensive rehabilitation unit of primary care in a university-based system. Interventions: Not applicable. Main Outcome Measures: The Glasgow Outcome Scale (GOS), Disability Rating Scale (DRS), FIM(TM) instrument, and Neurobehavioural Rating Scale (NRS), as well as single-photon emission computed tomography (SPECT) and magnetic resonance imaging. Results: PTH was found in 45% of patients. Risk factors for PTH were as follows: age (P<.04), duration of coma (P<.0001), and decompressive craniectomy (P<.0001). PTH correlated with the degree of hypoperfusion in the temporal lobes (P<.001). Patients who showed clinical deterioration improved after surgery. PTH correlated significantly with GOS, DRS. FIM, and NRS (P<.0001) I year after the trauma, and it influenced the appearance of posttraumatic epilepsy (P<.02). Conclusions: PTH concerns about 50% of patients with severe TBI. It influences functional and behavioral outcome and the appearance of posttraumatic epilepsy. The selection of patients for surgery can be defined principally on a clinical basis. SPECT may be helpful for differentiating ventricular enlargement due to cortical atrophy and hydrocephalus.