Hydrocephalus and Cerebrospinal Fluid Analysis Following Severe Traumatic Brain Injury: Evaluation of a Prospective Cohort
The development of hydrocephalus after severe traumatic brain injury (TBI) is an under-recognized healthcare phenomenon and can increase morbidity. The current study aims to characterize post-traumatic hydrocephalus (PTH) in a large cohort. Patients were prospectively enrolled age 16–80 years old wi...
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MDPI AG
2021-10-01
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| Series: | Neurology International |
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| Online Access: | https://www.mdpi.com/2035-8377/13/4/52 |
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| author | Hansen Deng Ezequiel Goldschmidt Enyinna Nwachuku John K. Yue Federico Angriman Zhishuo Wei Nitin Agarwal Ava M. Puccio David O. Okonkwo |
| author_facet | Hansen Deng Ezequiel Goldschmidt Enyinna Nwachuku John K. Yue Federico Angriman Zhishuo Wei Nitin Agarwal Ava M. Puccio David O. Okonkwo |
| author_sort | Hansen Deng |
| collection | DOAJ |
| description | The development of hydrocephalus after severe traumatic brain injury (TBI) is an under-recognized healthcare phenomenon and can increase morbidity. The current study aims to characterize post-traumatic hydrocephalus (PTH) in a large cohort. Patients were prospectively enrolled age 16–80 years old with Glasgow Coma Scale (GCS) score <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mo>≤</mo></semantics></math></inline-formula>8. Demographics, GCS, Injury Severity Score (ISS), surgery, and cerebrospinal fluid (CSF) were analyzed. Outcomes were shunt failure and Glasgow Outcome Scale (GOS) at 6 and 12-months. Statistical significance was assessed at <i>p</i> < 0.05. In 402 patients, mean age was 38.0 ± 16.7 years and 315 (78.4%) were male. Forty (10.0%) patients developed PTH, with predominant injuries being subdural hemorrhage (36.4%) and diffuse axonal injury (36.4%). Decompressive hemicraniectomy (DHC) was associated with hydrocephalus (OR 3.62, 95% CI (1.62–8.07), <i>p</i> < 0.01). Eighteen (4.5%) patients had shunt failure and proximal obstruction was most common. Differences in baseline CSF cell count were associated with increased shunt failure. PTH was not associated with worse outcomes at 6 (<i>p</i> = 0.55) or 12 (<i>p</i> = 0.47) months. Hydrocephalus is a frequent sequela in 10.0% of patients, particularly after DHC. Shunt placement and revision procedures are common after severe TBI, within the first 4 months of injury and necessitates early recognition by the clinician. |
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| issn | 2035-8377 |
| language | English |
| last_indexed | 2024-03-10T03:25:34Z |
| publishDate | 2021-10-01 |
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| series | Neurology International |
| spelling | doaj.art-a2521be98c2744a091899d91fd011a842023-11-23T09:53:26ZengMDPI AGNeurology International2035-83772021-10-0113452753410.3390/neurolint13040052Hydrocephalus and Cerebrospinal Fluid Analysis Following Severe Traumatic Brain Injury: Evaluation of a Prospective CohortHansen Deng0Ezequiel Goldschmidt1Enyinna Nwachuku2John K. Yue3Federico Angriman4Zhishuo Wei5Nitin Agarwal6Ava M. Puccio7David O. Okonkwo8Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USADepartment of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USADepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USADepartment of Critical Care Medicine, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON M4N 3M5, CanadaDepartment of Critical Care Medicine, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON M4N 3M5, CanadaDepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USADepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USADepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USADepartment of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USAThe development of hydrocephalus after severe traumatic brain injury (TBI) is an under-recognized healthcare phenomenon and can increase morbidity. The current study aims to characterize post-traumatic hydrocephalus (PTH) in a large cohort. Patients were prospectively enrolled age 16–80 years old with Glasgow Coma Scale (GCS) score <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mo>≤</mo></semantics></math></inline-formula>8. Demographics, GCS, Injury Severity Score (ISS), surgery, and cerebrospinal fluid (CSF) were analyzed. Outcomes were shunt failure and Glasgow Outcome Scale (GOS) at 6 and 12-months. Statistical significance was assessed at <i>p</i> < 0.05. In 402 patients, mean age was 38.0 ± 16.7 years and 315 (78.4%) were male. Forty (10.0%) patients developed PTH, with predominant injuries being subdural hemorrhage (36.4%) and diffuse axonal injury (36.4%). Decompressive hemicraniectomy (DHC) was associated with hydrocephalus (OR 3.62, 95% CI (1.62–8.07), <i>p</i> < 0.01). Eighteen (4.5%) patients had shunt failure and proximal obstruction was most common. Differences in baseline CSF cell count were associated with increased shunt failure. PTH was not associated with worse outcomes at 6 (<i>p</i> = 0.55) or 12 (<i>p</i> = 0.47) months. Hydrocephalus is a frequent sequela in 10.0% of patients, particularly after DHC. Shunt placement and revision procedures are common after severe TBI, within the first 4 months of injury and necessitates early recognition by the clinician.https://www.mdpi.com/2035-8377/13/4/52post-traumatic hydrocephalustraumatic brain injuryventriculoperitoneal shuntdecompressive hemicraniectomyshunt failurecerebrospinal fluid |
| spellingShingle | Hansen Deng Ezequiel Goldschmidt Enyinna Nwachuku John K. Yue Federico Angriman Zhishuo Wei Nitin Agarwal Ava M. Puccio David O. Okonkwo Hydrocephalus and Cerebrospinal Fluid Analysis Following Severe Traumatic Brain Injury: Evaluation of a Prospective Cohort Neurology International post-traumatic hydrocephalus traumatic brain injury ventriculoperitoneal shunt decompressive hemicraniectomy shunt failure cerebrospinal fluid |
| title | Hydrocephalus and Cerebrospinal Fluid Analysis Following Severe Traumatic Brain Injury: Evaluation of a Prospective Cohort |
| title_full | Hydrocephalus and Cerebrospinal Fluid Analysis Following Severe Traumatic Brain Injury: Evaluation of a Prospective Cohort |
| title_fullStr | Hydrocephalus and Cerebrospinal Fluid Analysis Following Severe Traumatic Brain Injury: Evaluation of a Prospective Cohort |
| title_full_unstemmed | Hydrocephalus and Cerebrospinal Fluid Analysis Following Severe Traumatic Brain Injury: Evaluation of a Prospective Cohort |
| title_short | Hydrocephalus and Cerebrospinal Fluid Analysis Following Severe Traumatic Brain Injury: Evaluation of a Prospective Cohort |
| title_sort | hydrocephalus and cerebrospinal fluid analysis following severe traumatic brain injury evaluation of a prospective cohort |
| topic | post-traumatic hydrocephalus traumatic brain injury ventriculoperitoneal shunt decompressive hemicraniectomy shunt failure cerebrospinal fluid |
| url | https://www.mdpi.com/2035-8377/13/4/52 |
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