Hydrocephalus

Hydrocephalus secondary to SAH may be obstructive, caused by direct intraventricular obstruction, or communicating, caused by an interference with the absorption of CSF through the arachnoid villi. It is seen in 10-35% of patients presenting with SAH, with 25-35% of individuals requiring external ventricular drainage [22]. Approximately 50-60% of individuals requiring external ventricular drainage will ultimately require ventriculo-peritoneal shunts [22]. Disadvantages of external ventricular drainage include an increased risk of re-bleed (14%), parenchymal hemorrhage, infection and ventriculitis. The rate of infection varies according to the series but is approximately 10%. Some authors believe that premature drainage of CSF may increase the likelihood of the patient ultimately requiring a ventriculo-peritoneal shunt. Factors associated with the development of chronic hydrocephalus include IVH, hydro-cephalus present on admission CT scan, older age, poor grade at admission, pre-morbid hypertension and Fisher grade.

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