Transient Acute Hydrocephalus After Spontaneous Intracranial Bleeding in Adults

Background: Acute hydrocephalus (AH) is commonly encountered after spontaneous or traumatic intracranial bleeding in adults. In the setting of AH, external ventricular drainage is usually proposed as the urgent management. But in rare occasions, AH could be transient and resolve spontaneously without invasive management. Although its actual incidence might be higher, only a few case reports on transient AH (TAH) after spontaneous intracranial bleeding in adults have been reported.

Methods: A retrospective review of the medical records of the patients admitted for spontaneous intracranial bleeding was performed at the neurosurgical department of our institution. We also performed a systematic PubMed search of the published studies written in English for patients developing TAH after spontaneous intracranial bleeding.

Results: In all there were 10 patients (5 women) including 5 cases in our case series. The time interval from hemorrhagic ictus to AH ranged from 7 hours to 9 days; although the time interval from AH to evident resolution ranged from 50 minutes to 9 days. No patient experienced recurrence of AH or shunt-dependent hydrocephalus in the long term.

Conclusions: The osmotic and hydrostatic state in the microvessels, lymphatic pathways for the drainage of the interstitial fluid and cerebrospinal fluid, and aquaporins on the astrocytes of the patients might have important roles in the genesis and resolution of TAH. The difficulty at present is to differentiate the patients who would experience TAH from those needing surgical interventions. If surgical intervention could not be carried out temporarily, vigilant monitoring and osmotic diuretics are proposed.