Clinical Neuroscience

[Importance of hydrocephalus following severe brain injury during postacute rehabilitation]

DÉNES Zoltán, LANTOS Ágnes, SZÉL István, THOMKA Magdolna, VASS Mátyás, BARSI Péter

NOVEMBER 30, 2010

Clinical Neuroscience - 2010;63(11-12)

[Objectives - We report our experiences with hydrocephalus in early rehabilitation over a seven-year period. Method - Retrospective study in Brain Injury Rehabilitation Unit of the National Institute for Medical Rehabilitation, between 1 January 2002 and 31 December 2008. Results - At our institute in the last seven years, we treated 83 patients with secondary and six patients with primary hydrocephalus. The majority of hydrocephalus was of post traumatic origin (52) and remaining 23 following stroke (SAH, AVM, ICH) or brain operation (tumour - seven, and one cranioplasty), and all these patients had undergone ventricular shunt implantation. Mean age of patients was 36 (14-80) years. Hydrocephalus was diagnosed in our rehabilitation unit in 20 of 83 cases and the other patients were shunted before transfer to our unit. The median time point of shunting was 70 (range: 20-270) days after trauma, brain surgery or stroke. Post-operative complications were seen in 12 of 89 patients: six infections and six shunt failure and revision was necessary in 14%. In PTH cases, the post-operative improvement was seen in 40 of 52 patients being shunted and corresponded to FIM scores. At the other 31 cases, with non-traumatic origin, only two patients remain unchanged. Conclusions - Hydrocephalus is considered to be a frequent and important complication after severe brain damage. The incidence of hydrocephalus treated with shunt implantation in our neuro-rehabilitation unit was 4.4%. The postoperative improvement was 77%. Posttraumatic hydrocephalus concerns 5.2% of patients with severe TBI during last seven years in our institution. Diagnosis of posttraumatic hydrocephalus was established in 24%, and complication after shunt implantation (14%) was also recognized in the post-acute rehabilitation unit. It is strongly recommended for the team working at such type of units to obtain clinical practice. Teamwork, good cooperation between acute and postacutecare is necessary for successful rehabilitation of these patients.]

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