Risk factors of delayed intracerebral hemorrhage

Abstract

Objective A ventriculoperitoneal (VP) shunt is a common neurosurgical procedure for cerebrospinal fluid (CSF) diversion. However, it is associated with many complications. Delayed intracerebral hemorrhage (ICH), which is one of rare type complication following VP shunt had been reported in a few cases. The author investigated the incidence and risk factors of development for delayed ICH following VP shunt.

Methods One hundred and sixty-seven patients received a VP shunt for hydrocephalus over 11 years and 138 patients were eligible for this study. All medical records and computed tomography (CT) scans obtained within 48 hours after operation and 7 days postoperative were reviewed. Brain CT were performed immediately after neurological deficits developed. The risk factors of development for delayed ICH (≥ 48 hours after VP shunt) were analyzed according to the demographic data including sex and age, original intracranial lesions, co-morbid diseases, and laboratory findings.

Results Delayed ICH following VP shunt developed in 34 (24%) of 138 patients. Risk factors of delayed ICH were age (p = 0.037) and partial thromboplastin time (PTT) (p = 0.032). Other clinical parameters were not associated with development of delayed ICH statistically. Intraventricular hemorrhage (IVH) after VP Shunt was most common in 16 cases. Hemorrhagic volume was less than 1 ㎖ in 28 cases, and more than 1 ㎖ in 6 cases.

Conclusions This study suggests that old age and delayed PTT are major risk factors for development of delayed ICH following VP shunt. In addition, delayed ICH after VP shunt commonly occurs even when most patients are asymptomatic. Therefore, careful observation should be paid attention during the follow-up period to whom underwent a VP shunt.