title: Post-hemorrhagic hydrocephalus presenting as cauda equina syndrome in a patient with spinal dysraphism.
abstract: Hydrocephalus has varied presentations in patients with a history of spinal dysraphism. This is a unique case of post-subarachnoid hemorrhage hydrocephalus presenting as cauda equina syndrome. We report on a 32-year-old woman with remotely repaired spinal defect who experienced subarachnoid hemorrhage and underwent anterior communicating artery aneurysm clipping. Post-operatively, she developed urinary and fecal incontinence as the sole presenting symptom of communicating post-hemorrhagic hydrocephalus. New neurological deficits in this population can also be attributed to recurrent cord tethering or syrinx, both of which were demonstrated on her lumbar spine MRI, but her incontinence resolved with external ventricular drain placement and cerebrospinal fluid diversion. There are few case reports of patients with closed neural tube defects and hydrocephalus and none in the adult population to our knowledge. Neurological change in patients with any history of spinal dysraphism may reflect altered cerebrospinal fluid dynamics affecting either end of the neuraxis.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower 6115F, Baltimore, MD 21287, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Bender
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower 6115F, Baltimore, MD 21287, USA.
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Colby
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower 6115F, Baltimore, MD 21287, USA. Electronic address: jhuang24@jhmi.edu.
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
mesh_terms: D000328:Adult; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology*; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000009:adverse effects; D011128:Polyradiculopathy / Q000209:etiology*; D016135:Spinal Dysraphism / Q000150:complications*; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013525:Surgical Instruments
keywords: Cauda equina; Hydrocephalus; Spinal dysraphism; Subarachnoid hemorrhage