Recognition and Treatment of Hydrocephalus Following Spontaneous Subarachnoid Hemorrhage

Abstract

E XTRAVENTRICULAR obstructive hydrocephalus following spontaneous subarachnoid hemorrhage in adults has been the subject of previous reports; 2,6,s,12, 13.1s,22,23 the ventricular dilatation is postulated to occur secondary to an adhesive arachnoidal reaction caused by the bleeding and leading to an obstruction of the cercbrospinal-fluid pathways. The appearance of the hydrocephalus often is delayed, for fibrosis of the meninges is thought to require at least 10-14 days to develop following subarachnoid hemorrhage. 1~ Such a pathological process has been produced in the meninges of young dogs by Bagley 3 after repeated injections of blood into the cisterna magna or over the cerebral hemispheres. A more recent study 1~ and personal data obtained in adult dogs with experimental subarachnoid hemorrhage, however, demonstrated hydrocephalus in only a very small number of animals receiving blood into the chiasmatic cistern. Moreover, it is well known that in many patients with subarachnoid hemorrhage of spontaneous, traumatic, or operative origin a progressive hydrocephalus does not develop. The exact factors leading to sufficient reaction in the meninges with resultant hydrocephalus have eluded precise definition, and no statistics are available on the incidence of this complication in a large series of adults. Relevant data are available, however, in infantile hydrocephalus. Laurence 14 has determined, either by air study or autopsy, that the site of obstruction of fluid occurred at the exit foramina of the fourth ventricle or within the basal cisterns in 48 per cent of