Post-traumatic hydrocephalus: Presentation, management and outcome - An apex trauma centre experience

The reported incidence of post-traumatic hydrocephalus (PTH) in literature varies from 0.7-29%. It is a treatable complication of head injury and presents with different clinical syndromes. We manage 38 cases of post-traumatic hydrocephalus in our hospital between January 2009 and April 2010. Clinicoradiology was studied at initial trauma, and at presentation with symptoms suggestive of increased ICP. Post ventriculo-peritoneal shunt outcome was analyzed. Sixty-eight percent cases were of severe head injury. Contusions (73.6%) and SAH (50%) were the most common CT findings. Sixty-five percent cases had been managed by decompressive craniectomy at the time of initial injury. Deterioration in consciousness (57.8%) and hemiparesis (26.3%) were most common presenting features of PTH, usually after 65±38 days (mean±SD) of initial injury. Patients were managed by antibiotic impregnated ventriculo-peritoneal shunt. Shunt revision and infection rates were 18.4% and 12.8% respectively. Thirty cases (78.9%) improved, 2 (5.2%) showed no improvement and 6 (15.7%) died. PTH is a treatable complication of head injury with a favorable outcome and therefore should be aggressively managed by CSF shunting.