Medical Student LECOM Kendall Park, New Jersey, United States
Case Diagnosis: Intracerebral Hemorrhage Secondary to Cerebellar AVM with communicating hydrocephalus and meningocele
Case Description: Patient is a 30 yo male with incidentally dx AVM on 7/9/22 who presented for rupture/L ICH on 1/10/23 iso cerebellar AVM. S/p suboccipital hemicraniectomy, R frontal EVD placement, and balloon assisted embolization was discharged on 2/2023. During that time, endorsed short-term memory loss and ambulating with a cane. Patient was readmitted on 5/10/2023 for repeat embolization and surgical resection via supraorbital craniotomy. Course c/b communicating hydrocephalus, s/p VP shunt and EVD removal. In addition, due to large symptomatic meningocele, LP shunt was also placed. CTH demonstrated improvement of IVH with decreased size of ventricles. Admitted to rehab services to help improve deconditioning, ataxic gait, urinary retention, and diplopia.
Discussions: Patients with communicating hydrocephalus are managed with a LP or VP shunt. Previous literature has shown that VP and LP shunts are both similarly effective in treating communicating hydrocephalus. However the excess buildup of CSF fluid prompted the patient to require both shunts which were successful in decreasing the size of ventricles and improving the patients IVH. There may be a relation between the communicating hydrocephalus and symptomatic meningoceles which prompted the patient to receive more than one shunt. VP shunts have now been reported to have more complications within the first year of insertion than LP shunts. Therefore, during the patient's rehabilitation it would be essential to monitor for any complications that may be caused by VP shunts such as shunt malfunction, headaches, visual changes, infections, seizures and shunt obstruction.
Conclusions: This case portrays a unique scenario in which a VP and LP shunt were both utilized for effective relief of communicating hydrocephalus and meningocele in an effort to reduce excess CSF accumulation.
