Cerebral hemorrhage after shunt for idiopathic normal pressure hydrocephalus with asymptomatic cerebral hemorrhage

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  • Tanaka Tatsuya
    Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita
  • Michiwaki Yuhei
    Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita
  • Wakamiya Tomihiro
    Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita
  • Tabei Yusuke
    Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Mita
  • Oyama Kenchi
    Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Mita
  • Shimoji Kazuaki
    Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita
  • Suehiro Eiichi
    Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita
  • Yamane Fumitaka
    Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita
  • Kawashima Masatou
    Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita
  • Matsuno Akira
    Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita

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Other Title
  • 脳室腹腔短絡術術後に無症候性脳出血瘢痕部に症候性脳出血を来した特発性正常圧水頭症の１例
  • ノウシツフクコウ タンラクジュツ ジュツゴ ニ ムショウコウセイ ノウシュッケツハンコンブ ニ ショウコウセイ ノウシュッケツ オ キタシタ トクハツセイ セイジョウアツ スイトウショウ ノ 1レイ

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Abstract

<p>  We report the case of a 76‒year‒old Japanese male with a history of hypertension, diabetes, cerebral infarction, and iliac artery stenosis on dual antiplatelet therapy who presented with dementia, gait disturbance, and urinary incontinence that had progressed for approx. 10 years. Magnetic resonance imaging of the head showed an enlargement of the lateral ventricles, asymptomatic cerebral hemorrhage, and microhemorrhage in the putamen. We performed a ventriculoperitoneal shunt for possible idiopathic normal‒pressure hydrocephalus. However, on postoperative day 10, the patient developed consciousness disorder and left hemiplegia after an unwitnessed fall he experienced 4 days after the change of the shunt valve’s pressure to low pressure. Computed tomography showed a right putamen hemorrhage. This case demonstrates that (i) overdrainage after a shunt can also induce cerebral hemorrhage, and (ii) it is necessary to consider appropriate cerebrospinal fluid management and reduce antithrombotic drugs in such cases.</p>

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