title: Intracerebral hemorrhage secondary to ventriculoperitoneal shunt insertion--four case reports.
abstract: Four patients presented with intracerebral hemorrhage secondary to ventriculoperitoneal (VP) shunt insertion. VP shunt insertion was performed for idiopathic normal-pressure hydrocephalus (Case 1), hydrocephalus after cerebellar hemorrhage (Case 2), and subarachnoid hemorrhage followed by meningitis (Cases 3 and 4). Cerebral hemorrhage was confirmed 4 hours (Case 1), 2 days (Case 2), 7 days (Case 3), and 13 days (Case 4) after the operation. Cases 1 and 2 required intraoperative hemostasis for bleeding from the cortical vein. The 7 previous and our 4 patients were divided according to early (within 2 days after shunt placement, n = 6, Group 1) and delayed (5-13 days post-shunting, n = 5, Group 2) hemorrhage. Bleeding was attributable to venous occlusion due to intraoperative manipulation in Group 1, and to the vulnerability of brain tissue induced by a primary brain disease in Group 2.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. misaki@ns.m.kanazawa-u.ac.jp
authors.forename: Kouichi
authors.initials: K
authors.lastname: Misaki
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Uchiyama
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Jun-ichiro
authors.initials: J
authors.lastname: Hamada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D006850:Hydrocephalus, Normal Pressure / Q000150:complications / Q000601:surgery; D007049:Iatrogenic Disease / Q000517:prevention & control; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008581:Meningitis / Q000150:complications; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D019919:Prosthesis Implantation / Q000009:adverse effects*; D011859:Radiography; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*