Discussion:
Surgical evacuation has been the mainstay of treatment for CSDH,
especially if the hematoma is large and the patient shows significant
neurological symptoms, a mass effect, or a significant midline shift.
However, there have been some reports of spontaneous resolution of CSDH
over the years, and some interesting theories behind their resolution
have been proposed. None of these reports include a patient who develops
a CSDH specifically as a complication following VPS placement. This case
presents a unique scenario where a programmable ventriculoperitoneal
shunt (VPS) used to treat hydrocephalus led to the development of a
CSDH, which resolved spontaneously after adjusting the shunt pressure.
We discovered a possible intervention that could save the patient from
further morbidity by excluding the need for further surgery.
Keywords: Normal-pressure hydrocephalus, Chronic Subdural
Hematoma, Ventriculoperitoneal shunt, programmable VP shunt.
Introduction :
Normal-pressure hydrocephalus (NPH) is characterized by the triad,
including confusion, magnetic gait, and urinary incontinence caused by a
gradual blockage of cerebrospinal fluid (CSF) drainage. NPH is usually
idiopathic, but its etiology remains largely unknown. Management of
patients with NPH involves the placement of a ventriculoperitoneal shunt
to aid CSF drainage [1]. The placement of adjustable shunt valves
enables easy, non-invasive adjustments in the amount of CSF drainage to
maximize symptom relief and minimize over-drainage, thus reducing the
need for repeated surgical interventions to manage shunt pressure with
fixed pressure valves. Chronic Subdural Hematoma (CSDH) is a known
complication in patients undergoing VP shunt placement for NPH [2].
The risk of CSDH underscores the importance of carefully managing CSF
drainage in NPH patients. The advent of adjustable VP shunt valves has
transformed the management of NPH [3]. These devices offer the
advantage of non-invasive adjustments in CSF drainage rates, enabling
healthcare providers to fine-tune the shunt’s performance according to
the patient’s evolving condition. Herein, we are reporting a rare case
of CSDH, which was resolved following the placement of a programmable VP
shunt. The work has been reported per the SCARE criteria [4].