title: Hydrocephalus associated with childhood nonaccidental head trauma.
abstract: OBJECTIVE The incidence of posttraumatic ventriculomegaly (PTV) and shunt-dependent hydrocephalus after nonaccidental head trauma (NAHT) is unknown. In the present study, the authors assessed the timing of PTV development, the relationship between PTV and decompressive craniectomy (DC), and whether PTV necessitated placement of a permanent shunt. Also, NAHT/PTV cases were categorized into a temporal profile of delay in admission and evaluated for association with outcomes at discharge. METHODS The authors retrospectively reviewed the cases of patients diagnosed with NAHT throughout a 10-year period. Cases in which sequential CT scans had been obtained (n = 28) were evaluated for Evans' index to determine the earliest time ventricular dilation was observed. Discharge outcomes were assessed using the King's Outcome Scale for Childhood Head Injury score. RESULTS Thirty-nine percent (11 of 28) of the patients developed PTV. A low admission Glasgow Coma Scale (GCS) score predicted early PTV presentation (within < 3 days) versus a high GCS score (> 1 week). A majority of PTV/NAHT patients presented with a subdural hematoma (both convexity and interhemispheric) and ischemic stroke, but subarachnoid hemorrhage was significantly associated with PTV/NAHT (p = 0.011). Of 6 patients undergoing a DC for intractable intracranial pressure, 4 (67%) developed PTV (p = 0.0366). These patients tended to present with lower GCS scores and develop ventriculomegaly early. Only 2 patients developed hydrocephalus requiring shunt placement. CONCLUSIONS PTV presents early after NAHT, particularly after a DC has been performed. However, the authors found that only a few PTV/NAHT patients developed shunt-dependent hydrocephalus.
authors: The Cushing Neuroscience Institute and Department of Neurosurgery, Hofstra Northwell School of Medicine at Cohen Children's Medical Center and Northwell Health System, Manhasset, New York; and.
authors: Sudhakar
authors: S
authors: Vadivelu
authors: The Cushing Neuroscience Institute and Department of Neurosurgery, Hofstra Northwell School of Medicine at Cohen Children's Medical Center and Northwell Health System, Manhasset, New York; and.
authors: Harold L
authors: HL
authors: Rekate
authors: Department of Pediatrics, University of Florida School of Medicine at Shands Children's Hospital, Gainesville, Florida.
authors: Debra
authors: D
authors: Esernio-Jenssen
authors: The Cushing Neuroscience Institute and Department of Neurosurgery, Hofstra Northwell School of Medicine at Cohen Children's Medical Center and Northwell Health System, Manhasset, New York; and.
authors: Mark A
authors: MA
authors: Mittler
authors: The Cushing Neuroscience Institute and Department of Neurosurgery, Hofstra Northwell School of Medicine at Cohen Children's Medical Center and Northwell Health System, Manhasset, New York; and.
authors: Steven J
authors: SJ
authors: Schneider
mesh_terms: D002648:Child; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D015600:Glasgow Coma Scale / Q000639:trends; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D012189:Retrospective Studies
keywords: CPCT = child protection consultation team; GCS = Glasgow Coma Scale; IVH = intraventricular hemorrhage; KOSCHI = King's Outcome Scale for Childhood Head Injury; NAHT = nonaccidental head trauma; PTV = posttraumatic ventriculomegaly; SAH = subarachnoid hemorrhage; SDH = subdural hematoma; TBI = traumatic brain injury; biomarker; child abuse; excitotoxicity; hypoxia-ischemia; shaken baby syndrome; traumatic brain injury