From the Guidelines
Communicating hydrocephalus is a medical emergency that requires prompt evaluation and treatment, as it can lead to increased intracranial pressure and potentially life-threatening complications. This condition is characterized by the accumulation of cerebrospinal fluid (CSF) in the ventricles, leading to increased pressure and potentially causing symptoms such as headache, alteration in sensorium, gait abnormality, urinary incontinence, and nausea and vomiting 1. The presence of hydrocephalus can be evaluated through contrast-enhanced MRI, which can help distinguish between communicating and noncommunicating hydrocephalus, and lumbar puncture, which can measure the opening pressure and help guide treatment decisions.
Key considerations in the management of communicating hydrocephalus include:
- Prompt reduction of intracranial pressure through removal of CSF, with the goal of reducing the pressure to 50% of the opening pressure or 200 mm of H2O, whichever is greater 1
- Repeated lumbar punctures, at least daily for 4 days, until the pressure stabilizes to <250 mm H2O 1
- Consideration of medical therapy with azole antifungals and potential shunting procedures, such as lumboperitoneal or ventriculoperitoneal shunts, if medical therapy fails to stabilize the pressure 1
- Close monitoring of neurological status, with serial examinations to detect any signs of deterioration or increased intracranial pressure.
The urgency of communicating hydrocephalus stems from the potential for rapid deterioration and life-threatening complications, including brain herniation and death 1. Therefore, prompt recognition and treatment of this condition are essential to prevent long-term morbidity and mortality.
From the Research
Definition and Classification of Hydrocephalus
- Hydrocephalus is a broad term usually understood as cerebrospinal fluid (CSF) accumulation resulting in cerebral ventricular system expansion 2
- It is classified as either communicating or non-communicating, with communicating hydrocephalus understood as a deficit at cranial arachnoid villi and granulation absorption sites 2
Communicating Hydrocephalus as an Emergency
- There is evidence that communicating hydrocephalus can be a serious complication of certain medical treatments, such as stereotactic radiosurgery for periventricular meningiomas 3
- In some cases, communicating hydrocephalus can lead to sudden deterioration in clinical condition, requiring prompt medical attention 3
- However, there is also evidence that communicating hydrocephalus can be treated successfully with medications such as acetazolamide and repeated lumbar punctures, avoiding the need for surgical intervention in some cases 4
Treatment and Management of Hydrocephalus
- Treatment typically involves surgical shunt placement or endoscopic third ventriculostomy (ETV) technique with or without choroid plexus cauterization (CPC) 2
- In patients with severe disorders of consciousness, active treatment of hydrocephalus can significantly improve patients' consciousness and neurological function, even months or years after the onset of severe disorders of consciousness 5
- Individualized treatment strategies, including ventriculoperitoneal shunt implantation and cranioplasty, can be effective in managing hydrocephalus in patients with severe disorders of consciousness 5