Delayed complications thirty-six years after hemispherectomy: a case report.
OBJECTIVE
To describe a late complication of hemispherectomy in a patient in whom symptoms of hydrocephalus developed 36 years after her left-sided hemispherectomy, the longest delay on record.


METHODS
Hemispherectomy has been successfully used in the treatment of intractable epilepsy associated with infantile-type hemiplegia for a half century. Of the patients, however, up to 33% have late increased cerebrospinal fluid pressure complications attributed to superficial cerebral hemosiderosis. Through a retrospective case analysis, we describe such complications in a 52-year-old woman with cognitive impairment, gait instability, urinary incontinence, and right hemineglect 36 years after her initial procedure.


RESULTS
Quantitative, objective measures of cognition and gait-laboratory testing confirmed the patient's favorable clinical response to ventriculoperitoneal shunting, as well as the complete resolution of her symptoms, including the atypical occurrence of right-sided hemineglect.


CONCLUSIONS
This case uniquely demonstrates the clinical features of a late complication of hemispherectomy while documenting the longest reported delay for developing such adverse sequelae. We also emphasize the need for more extensive follow-up studies to assess the extent of posthemispherectomy complications.
Kalkanis
S N
SN
Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Blumenfeld
H
H
Sherman
J C
JC
Krebs
D E
DE
Irizarry
M C
MC
Parker
S W
SW
Cosgrove
G R
GR
D001921:Brain / Q000601:surgery*; D001927:Brain Diseases / Q000209:etiology; D004827:Epilepsy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006486:Hemosiderosis / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000209:etiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt