Transient Obstructive Hydrocephalus due to Intraventricular Hemorrhage: A Case Report and Review of Literature
The patient was a 33-year-old male with a previously diagnosed Spetzler-Martin Grade 5 AVM in the left parietal lobe that had been treated conservatively. On the night prior to presentation he developed a sudden-onset, diffuse, severe headache that radiated to the suboccipital region. There was no nausea, vomiting, or loss of consciousness.\nOn the initial assessment the patient was awake, alert, and fully oriented. There were no cranial nerve, motor, or sensory deficits. A fundoscopic examination revealed no papilledema or retinal hemorrhage. A CT scan at admission revealed IVH within the left frontal horn, both occipital horns, both temporal horns, and the third ventricle. There was no ventriculomegaly (). Comparison of this scan with previous CT scans did not suggest the early hydrocephalus. We were concerned about the possibility of recurrent hemorrhage or the development of hydrocephalus, and hence the patient was admitted to the neurosurgical intensive care unit (ICU) for close observation. A catheter angiogram and MRI scan obtained on the following morning revealed no change in the AVM (). A repeat head CT scan on the second day of hospitalization demonstrated stable IVH without ventriculomegaly. The patient was then transferred from the ICU to the neurosurgical ward for observation.\nApproximately 40 hours after initial presentation, the patient experienced severe headache with associated nausea. An urgent CT scan revealed the interval development of hydrocephalus, with the suggestion that a portion of the intraventricular thrombus had migrated from the left lateral ventricle to the junction of the third ventricle and the cerebral aqueduct (). There was no recurrence of IVH or subarachnoid hemorrhage. The patient was immediately transferred back to the ICU with anticipation of a need for ventriculostomy placement.\nShortly thereafter his headache began to improve. On examination the patient appeared more comfortable and was not lethargic. He remained without focal neurological deficits. The headache resolved within 4 hours of onset. A ventricular drain was not placed, and the patient was monitored. Head CT performed 6 hours after the onset of headache and the first CT revealing hydrocephalus, showed an interval decrease in the ventricular size and further clot migration through the cerebral aqueduct (). There were no further clinical events during the hospital stay and the patient was discharged without further sequelae from his transient hydrocephalus.