Ventricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage

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✓ Ventricular dilatation following spontaneous subarachnoid hemorrhage (SAH) is a well recognized phenomenon. Its clinical significance, however, remains controversial. Two phases are distinguished, the acute or early, occurring soon after the ictus, and the chronic or late, developing after the second week. The authors studied the ventricular size in 210 patients with spontaneous SAH through the course of their illness and convalescence by means of serial computerized tomography (CT) scans. Their findings suggest that ventricular dilatation soon after SAH is not always clinically significant and does not necessarily require shunting before definitive surgery. Delayed symptomatic ventricular enlargement (communicating hydrocephalus) occurs in 7% of the patients and can be safely diagnosed on the basis of the clinical picture and CT scan appearances. Treatment with a ventricular shunting system is almost invariably rewarding.

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Address reprint requests to: John Vassilouthis, M.D., Department of Neurosurgery, 401 Military Hospital, Mesogion Street, Athens, Greece.

© AANS, except where prohibited by US copyright law.

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Figures

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    Computerized tomography scan showing the width of the lateral ventricles at the level of the foramina of Monro, immediately behind the head of the caudate nuclei (X), and the transverse inner diameter of the skull at the same level (Y).

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    Factors possibly related to the development of ventricular enlargement*

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    Computerized tomography scans showing marked ventricular dilatation 1 day after rupture of an anterior communicating artery aneurysm. Note the presence of blood in the basal cisterns, the interpedunculate cistern, the Sylvian fissures, and the interhemispheric fissure.

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    Computerized tomography scans showing marked ventricular enlargement 3 days following rupture of an anterior communicating artery aneurysm. Note the presence of blood clot in the lateral ventricles, third ventricle, and the interhemispheric fissure.

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    Computerized tomography scans. Left: Moderate to marked ventricular enlargement 3 months following rupture of a right posterior communicating artery aneurysm. Right: Six months following the ictus, there is spontaneous resolution of the ventricular enlargement. Note the presence of cerebral infarcts in the distribution of the right middle and posterior cerebral arteries on the right side.

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    Computerized tomography scans. Left: A very mild degree of ventricular dilatation is seen 8 days after rupture of an anterior communicating artery aneurysm. Note the presence of blood clot in the interhemispheric fissure and septum pellucidum. Right: One year later moderate to marked ventricular dilatation is seen. Note the presence of an infarct of the right frontal lobe following resolution of a postoperative intracerebral hematoma.

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    Computerized tomography scans. Left: Moderate ventricular dilatation 2 days following rupture of an anterior communicating artery aneurysm. Blood clot is seen in the interhemispheric fissure and the right occipital horn. Right: Diminution of the ventricular size is seen in a scan 5 days later.

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