Abstract
Objective We hypothesized that the subset of patients with early hydrocephalus following aneurysmal
subarachnoid hemorrhage may represent a subset of patients with a more vehement inflammatory
reaction to blood products in the subarachnoid space. We thus examined risk factors
for early hydrocephalus and examined the relationship between early hydrocephalus
and symptomatic vasospasm as well as clinical outcome.
Methods We retrospectively analyzed all patients presenting to our institution with subarachnoid
hemorrhage over a 7-year period. We examined for risk factors, including early hydrocephalus,
for poor clinical outcome and symptomatic vasospasm.
Results We found intraventricular hemorrhage to be strongly associated with the development
of early hydrocephalus. In univariate analysis, early hydrocephalus was strongly associated
with both poor functional outcome and symptomatic vasospasm. In multivariate analysis,
intraventricular hemorrhage and tobacco use were associated with symptomatic vasospasm;
intraventricular hemorrhage, intraparenchymal hemorrhage, and symptomatic vasospasm
were associated with poor functional outcome.
Conclusions We found that intraventricular hemorrhage was strongly associated with early hydrocephalus.
Further exploration of the mechanistic explanation is needed, but we suggest this
may be from a combination of obstruction of cerebrospinal fluid pathways by blood
products and inflammation in the choroid plexus resulting in increased cerebrospinal
fluid production. Further, we suggest that both early hydrocephalus and cerebral vasospasm
may be parts of the overall inflammatory cascade that occurs with intraventricular
hemorrhage and ultimately results in a poorer clinical outcome.
Keywords
aneurysm - hydrocephalus - endovascular coiling - subarachnoid - hemorrhage
