Hydrocephalus is an independent factor affecting morbidity and mortality of ICH patients: Systematic review and meta-analysis

Background

Despite advances in our knowledge of the causes, preventions, and treatments of stroke, it continues to be a leading cause of death and disability. The most common type of stroke-related morbidity and mortality is intracerebral haemorrhage (ICH). Many prognostication scores include an intraventricular extension (IVH) after ICH because it affects mortality independently. Although it is a direct result of IVH and results in significant damage, hydrocephalus (HC) has never been taken into account when calculating prognostication scores. This study aimed to evaluate the significance of hydrocephalus on the outcomes of ICH patients by meta-analysis.

Methods

Studies that compared the rates of mortality and/or morbidity in patients with ICH, ICH with IVH (ICH ​+ ​IVH), and ICH with IVH and HC (ICH ​+ ​IVH ​+ ​HC) were identified. A meta-analysis was performed by using Mantel-Haezel Risk Ratio at 95% significance.

Results

This meta-analysis included thirteen studies. The findings indicate that ICH ​+ ​IVH ​+ ​HC has higher long-term (90-day) and short-term (30-day) mortality risks than ICH (4.26 and 2.30 higher risks, respectively) and ICH ​+ ​IVH (1.96 and 1.54 higher risks). Patients with ICH ​+ ​IVH ​+ ​HC have lower rates of short-term (3 months) and long-term (6 months) good functional outcomes than those with ICH (0.66 and 0.38 times) or ICH ​+ ​IVH (0.76 and 0.54 times). Confounding variables included vascular comorbidities, haemorrhage volume, midline shift, and an initial GCS score below 8.

Conclusion

Hydrocephalus causes a poorer prognosis in ICH patients. Thus, it is reasonable to suggest the inclusion of hydrocephalus in ICH prognostication scoring systems.

Giant cerebral hydatid cyst with intraventricular extension: A rare case report with imaging findings

Hydatid cyst is the condition caused by larvae of the parasite Echinococcus granulosus, usually involving the liver, lung, and spleen. Involvement of the cerebrum with a hydatid cyst is a rare entity, comprising 2%-3% of all cases of hydatidosis. Intraventricular extension of cerebral hydatid cysts occurs in only a limited percentage of cases. Cerebral hydatid cysts can present with nonspecific symptoms, usually with features of raised intracranial pressure. Therefore, it is crucial to consider cerebral hydatid cysts as a potential diagnosis, especially in pediatric patients with nonspecific neurological symptoms, particularly those from areas endemic to the parasite. We report a case of a 9-year-old girl who presented with progressive headache and vomiting, with imaging findings suggestive of a giant hydatid cyst in the brain. She was managed surgically with a good outcome.