Subdural haematoma complicating shunting for normal pressure hydrocephalus in the setting of concomitant antiplatelet medication - a report of 11 cases.
OBJECTIVE
To report on the occurrence and management of subdural haematoma after shunt implantation for normal pressure hydrocephalus and to determine the risk of recurrence in the setting of antiplatelet medication.


METHODS
From a consecutive series of 80 patients implanted with a cerebrospinal fluid shunt for normal pressure hydrocephalus, records from 11 patients taking antiplatelet drugs, who subsequently had surgery for subdural haematoma were extracted and retrospectively reviewed.


RESULTS
Patients were followed up for a mean of 1819 days after shunt implantation. Subdural haematomas occurred at a median of 335 days after shunt implantation - four ipsilateral, five contralateral and two bilateral with respect to the ventricular catheter. Three patients had reoperations done within a week without having resumed antiplatelet medication in the interim. One of them had three further reoperations done before the subdural collection disappeared. Only one patient had a late recurrence almost 11 years after shunt implantation.


CONCLUSIONS
Subdural haematoma in the setting of a ventriculoperitoneal implantation for normal pressure hydrocephalus and concomitant antiplatelet medication can be managed along usual lines. Antiplatelet medication can be recommenced in due course with a low risk of recurrence.
a Department of Neurosurgery , Odense University Hospital , Odense , Denmark ;
Peter
P
Birkeland
b Department of Orthopaedic Surgery , Odense University Hospital , Odense , Denmark ;|c Institute of Clinical Research , University of Southern Denmark , Denmark.
Jens
J
Lauritsen
a Department of Neurosurgery , Odense University Hospital , Odense , Denmark ;|c Institute of Clinical Research , University of Southern Denmark , Denmark.
Frantz Rom
FR
Poulsen
D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use*; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
Acute subdural haematoma; cerebrospinal fluid shunt; chronic subdural haematoma; normal pressure hydrocephalus