Very low pressure hydrocephalus

Report of two cases

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✓ Low-pressure hydrocephalus is an extremely rare condition. Authors of the few previous reports on this subject have suggested that symptoms are gradual in onset and successfully treated. In this report the authors presented two unique cases of very low pressure hydrocephalus in which the patients experienced rapid deterioration requiring negative-pressure cerebrospinal fluid drainage to achieve the best possible neurological function; outcomes in both patients ultimately were poor. The constellation of findings suggests that this may be a distinct clinical entity.

Abbreviations used in this paper: CSF = cerebrospinal fluid; CT = computed tomography; EVD = external ventricular drain; GCS = Glasgow Coma Scale; ICP = intracranial pressure; NPH = normal-pressure hydrocephalus; VP = ventriculoperitoneal.

Article Information

Address reprint requests to: Michelle J. Clarke, M.D., Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. email: Clarke.michelle@mayo.edu.

© AANS, except where prohibited by US copyright law.

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    Case 1. Computed tomography scans demonstrating variability in ventricle size indicative of compliance. A: Admission CT scan of the head obtained on hospital Day 1. The patient’s GCS score was 14. B: Computed tomography was repeated 12 hours later, after the patient exhibited a precipitous decline in mental status, and the ventricles had obviously enlarged. C: Day 2. Following removal of the VP shunt and placement of an EVD at a pressure setting of 10 cm H2O, the ventricles are shown to have again increased in size. D: Day 2. Aggressive bedside drainage was performed, and the patient showed immediate improvement in mental status. E: Day 10. Development of hydrocephalus developed after an attempt to set the EVD to a pressure of 0 cm H2O. F: A CT scan obtained the day of discharge from the hospital. G: Day 120. A follow-up CT scan of the head obtained 3 months postoperatively, demonstrating stable ventricle size.

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