title: Giant acute epidural hematoma after ventriculoperitoneal shunt: a case report and literature review.
abstract: Cerebrospinal fluid over-drainage is a common complication of ventriculoperitoneal devices. In terms of haemorrhage, subdural haematomas are usually more frequent lesions than epidural hematomas, which, more rarely, may also be seen after ventricular shunt procedures and may lead to rapid neurological decline and even death unless a surgical procedure can be promptly performed. This study reports the case of a 47 years-old Dandy Walker man, with clinical condition compatible with the diagnosis of normal pressure hydrocephalus submitted to a ventriculoperitoneal shunt with a high fixed pressure valve. After discharge, on the second day after the procedure, he presented with headache and impaired level of consciousness. At hospital admission he was in a coma and anisochoric. Underwent endotracheal intubation and a head CT, showed epidural hematoma. We performed emergency craniotomy to drain the hematoma, the patient died in the operating room despite resuscitation attempts. In conclusion, prompt diagnosis and emergency craniotomy is recommended in these cases. We must be aware of this possible evolution and maintain high suspicion besides a longer in-hospital observation after these procedures.
authors.affiliation: Division of Neurosurgery, University of Sao Paulo Medical School Sao Paulo, Brazil.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Noleto
authors.affiliation: Division of Neurosurgery, University of Sao Paulo Medical School Sao Paulo, Brazil.
authors.forename: Iuri Santana
authors.initials: IS
authors.lastname: Neville
authors.affiliation: Division of Neurosurgery, University of Sao Paulo Medical School Sao Paulo, Brazil.
authors.forename: Wagner Malagó
authors.initials: WM
authors.lastname: Tavares
authors.affiliation: Division of Neurosurgery, University of Sao Paulo Medical School Sao Paulo, Brazil.
authors.forename: Felippe
authors.initials: F
authors.lastname: Saad
authors.affiliation: Division of Neurosurgery, University of Sao Paulo Medical School Sao Paulo, Brazil.
authors.forename: Fernando Campos
authors.initials: FC
authors.lastname: Pinto
authors.affiliation: Division of Neurosurgery, University of Sao Paulo Medical School Sao Paulo, Brazil.
authors.forename: Manoel Jacobsen
authors.initials: MJ
authors.lastname: Teixeira
authors.affiliation: Division of Neurosurgery, University of Sao Paulo Medical School Sao Paulo, Brazil.
authors.forename: Wellingson Silva
authors.initials: WS
authors.lastname: Paiva
keywords: Hydrocephalus; epidural hematoma; ventriculoperitoneal shunt