Acute post-traumatic hydrocephalus in an infant due to aqueductal obstruction by a blood clot: a case report

Acute hydrocephalus following post-traumatic peri-mesencephalic subarachnoid hemorrhage: an uncommon and potentially fatal event in children

PURPOSE

In pediatric, head trauma acute hydrocephalus is an uncommon but possible complication. Association with a subarachnoid hemorrhage is poorly described.

METHODS

We described a case of an 8-year-old girl with acute hydrocephalus secondary to peri-mesencephalic subarachnoid hemorrhage after mild head trauma resolved with external ventricular drainage. Furthermore, we have conducted a review of the literature about this complication in pediatric head trauma.

DISCUSSION AND CONCLUSION

Acute hydrocephalus related to post-traumatic peri-mesencephalic subarachnoid hemorrhage (tSAH) is an unknown entity in pediatric head trauma. According to our experience, traumatic peri-mesencephalic SAH should be under close clinical monitoring to identify post-traumatic hydrocephalus (PTH), a potentially fatal complication in pediatric mild head trauma.

Acute post-traumatic hydrocephalus in children due to aqueductal obstruction by blood clot: a series of 6 patients

INTRODUCTION

Post-traumatic hydrocephalus following head injury is a well-known entity. Most cases occur in patients with severe head injuries, often following decompressive craniectomy. On the contrary, acute post-traumatic hydrocephalus, caused by aqueductal obstruction by a blood clot, following mild head injury is uncommon.

CLINICAL MATERIAL

Six patients aged between 6 and 15 months presented hydrocephalus secondary to a blood clot in the aqueduct. Because of intracranial hypertension at presentation, 4 patients were urgently treated with external ventricular drains (EVDs). Post-operative course was uneventful. In 2 cases, EVDs were removed without further treatments. In 2 cases, hydrocephalus recurred. These patients were successfully treated with endoscopic third ventriculostomy. The remaining two patients developed symptoms a few days after the trauma. One, that presented hydrocephalus at imaging, was managed with a ventriculo-peritoneal shunt; the other, that presented subdural hygroma, was managed with subduro-peritoneal shunt that was removed later. All patients had complete recovery.

DISCUSSION AND CONCLUSION

Hydrocephalus secondary to clot in the aqueduct may rarely be the result of mild head injury in young children. Usually, prompt surgical management warrants a very good outcome. Most children may be treated without a permanent shunt, by using external drains and endoscopic third ventriculostomy.

C57BL/6-specific conditions for efficient in utero electroporation of the central nervous system

BACKGROUND

In utero electroporation is a fast an efficient tool to specifically address gene expression in the murine central nervous system. This technique was originally established in ICR/CD-1 outbred mice. Neuroanatomical differences between the different mouse strains and variations in gestation length require the optimization of the conditions for each strain to avoid severe complications. Furthermore the relevant position information is currently only scarcely standardized and not always easy to transfer to C57BL/6 mice.

NEW METHOD

In this study we present an improved method for in utero electroporation of C57BL/6 including a detailed atlas that allows for specific and efficient in vivo transfection. Further we introduce histogram analysis as a tool for neural migration assays.

RESULTS

We report individually adapted conditions for in utero electroporation in C57BL/6 mice that differ from the previously published data for ICR/CD-1 mice. Furthermore, this article outlines a detailed angle-map that allows for the specific and efficient in vivo transfection of different regions of the C57BL/6 mouse central nervous system. We also show that histogram analysis is a valuable tool for objectifying and accelerating postmitotic neural migration assays.

COMPARISON WITH EXISTING METHODS

Until now, conditions for in utero electroporation of C57BL/6 mice are sparsely defined. Further, compared with time-consuming cell body counting histogram analysis allows objectified and accelerated postmitotic neural migration assays.

CONCLUSION

Together, our results provide a manual for the in utero electroporation of specific regions of the central nervous systems C57BL/6 mice and objectified data analysis.

Transient Obstructive Hydrocephalus due to Intraventricular Hemorrhage: A Case Report and Review of Literature

Background

Acute transient obstructive hydrocephalus is rare in adults. We describe a patient with intraventricular hemorrhage (IVH) who experienced the delayed development of acute transient hydrocephalus.

Case Report

A 33-year-old man with a previously diagnosed Spetzler-Martin Grade 5 arteriovenous malformation presented with severe headache, which was found to be due to IVH. Forty hours after presentation he developed significant obstructive hydrocephalus due to the thrombus migrating to the cerebral aqueduct, and a ventriculostomy placement was planned. However, shortly thereafter his headache began to improve spontaneously. Within 4 hours after onset the headache had completely resolved, and an interval head CT scan revealed resolution of hydrocephalus.

Conclusions

In patients with IVH, acute obstructive hydrocephalus can develop at any time after the ictus. Though a delayed presentation of acute but transient obstructive hydrocephalus is unusual, it is important to be aware of this scenario and ensure that deterioration secondary to thrombus migration and subsequent obstructive hydrocephalus do not occur.