Shunting in chronic post-traumatic hydrocephalus: demonstration of neurophysiologic improvement.

The neuronal metabolic state that forms the cellular basis for cognitive functioning and motor behavior is dependent on cerebral perfusion. As intracerebral pressure increases, cerebral perfusion is compromised. The management of acute hydrocephalus after head trauma has been extensively described. In this article, we present evidence of clinical, cerebral perfusion, and neurophysiologic improvement in a 19-year-old patient with chronic post-traumatic hydrocephalus. Lethargy, gaze palsy, torticollis, and triplegia were noted 2 years postinjury in a neurologically stable patient. Computed axial tomography (CAT) scan confirmed marked enlargement of the third and fourth ventricles with a prominent subgaleal fluid collection. Intraoperative cerebral spinal fluid pressure was 26cm H2O despite hyperventilation. A ventriculo-peritoneal shunt was placed. Postoperatively, marked improvement in clinical exam, cerebral perfusion (SPECT scan), and evoked potentials correlated with the reemergence of the cerebral mantle on CAT scan and magnetic resonance imaging (MRI). Chronic obstructive hydrocephalus should be suspected and aggressively pursued in chronic head injury.