Trombosis Venosa Profunda

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Posttraumatic Hydrocephalus: A Clinical, Neuroradiologic, and Neuropsychologic Assessment of Long-Term Outcome
Letizia Mazzini, MD, Riccardo Campini, MD, Elisabetta Angelino, PhD, Felice Rognone, MD, Ilaria Pastore, MD, Giuseppe Oliveri, MD
ABSTRACT. Mazzini L, Campini R, Angelino E, Rognone F, Pastore I, Oliveri G. Posttraumatic hydrocephalus: a clinical, neuroradiologic, andneuropsychologic assessment of longterm outcome. Arch Phys Med Rehabil 2003;84:1637-41. Objectives: To detect the clinical and radiologic characteristics of posttraumatic hydrocephalus (PTH), to define its prognostic value, and to assess the effects of shunt surgery. Design: Correlational study on a prospective cohort. Setting: Brain injury rehabilitation center. Participants: One hundred forty patientswith severe traumatic brain injury (TBI) referred to an inpatient intensive rehabilitation unit of primary care in a university-based system. Interventions: Not applicable. Main Outcome Measures: The Glasgow Outcome Scale (GOS), Disability Rating Scale (DRS), FIM™ instrument, and Neurobehavioural Rating Scale (NRS), as well as single-photon emission computed tomography (SPECT) and magnetic resonanceimaging. Results: PTH was found in 45% of patients. Risk factors for PTH were as follows: age (P .04), duration of coma (P .0001), and decompressive craniectomy (P .0001). PTH correlated with the degree of hypoperfusion in the temporal lobes (P .001). Patients who showed clinical deterioration improved after surgery. PTH correlated significantly with GOS, DRS, FIM, and NRS (P .0001) 1 year afterthe trauma, and it influenced the appearance of posttraumatic epilepsy (P .02). Conclusions: PTH concerns about 50% of patients with severe TBI. It influences functional and behavioral outcome and the appearance of posttraumatic epilepsy. The selection of patients for surgery can be defined principally on a clinical basis. SPECT may be helpful for differentiating ventricular enlargement due to corticalatrophy and hydrocephalus. Key Words: Diagnosis; Hydrocephalus; Outcome assessment (health care); Rehabilitation; Treatment outcome. © 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation ENTRICULAR ENLARGEMENT is finding in the postacute phase severe brain injury (TBI); Vincidence varies fromof30% totraumatica common examinedits 86% of patients
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between 3 and 12 months after trauma, and it has been proposed as an index of severity of brain damage.3 The incidence of posttraumatic hydrocephalus (PTH), however, is significantly lower and ranges from .75%4 to 10.7%,5 but the diagnosis of true hydrocephalus is not always simple. Few studies have addressed the problems of the correlations between the characteristics ofPTH and the long-term clinical and functional outcome. Moreover, the criteria for selecting patients for shunt surgery in the postacute phase are not defined; hence, they are a source of debate.6-10 In this prospective study, a large number of patients were monitored for 1 year after severe TBI with the aim of detecting the clinical and radiologic characteristics of PTH, of defining its prognosticvalue for late clinical and functional outcome, and of assessing the effects of shunt surgery. METHODS One hundred forty patients (114 men, 26 women) affected by severe TBI were analyzed. The severity of injury was defined as a duration of coma of at least 6 hours and a Glasgow Coma Scale (GCS) total score of 8 or less in the acute phase. The patients were consecutively admitted from January 1995 toJanuary 2000. Anamnestic data and information about the principal events of the acute phase were collected from the case history taken in the intensive care unit. Patients were excluded from the analysis if they were known to have had neurologic deficits before the trauma. The mean interval from trauma to admission in the study was 56 37 days (range, 11–180d). The mean age standard deviation...