Complex HCP as Sequelae of Severe TBI Case Presentation

Abstract

Background: Post head injury HCP is not uncommon, its incidence up to 15% among all patients with TBI. The communicating type is more common in TBI than the noncommunicating type. In spite of being treatable sequelae of TBI but it may be complex one. Purpose: to report a case of complex hydrocephalus post sever TBI. Methods: Female child 6ys old presented at ER, after RTA 6months ago. GCS 7∕15, post traumatic epilepsy initial CT; brain edema. She suffering chest problems when she off MV and chest improved, CT brain; show HCP with Rt frontal hygroma, neurologically she has repeated fits and GCS 10∕15, conservative treatment. Not controlled follow up CT; disappeared hygroma and increased HCP. VP shunt inserted followed by immediate improvement. After discharge she get infection, readmitted managed conservatively , fever subside but conscious level not improved and fits not controlled , she developed distal shunt failure and CSF peritoneal pesudocyst. Distal revision was done followed by short period of improvement, then distal shunt failure and reformation of CSF peritoneal pesudocyst occurred. Lastly VA shunt was done followed by stabilization of the case improved conscious level and controlled fits and return normal activity. Results: the patient show neurological recovery from deep coma after proper management of post head injury HCP, and diversion to VA shunt instead VP shunt. Conclusion: Post head injury HCP possible cause of persistent altered neurological status. It's important to differentiating posttraumatic atrophy from posttraumatic hydrocephalus, and this need meticulous estimation of both radiological and clinical findings. Papilledema not always indicator of increased ICP.VA shunt is possible diversion with peritoneal CSF cyst formation.