CASE REPORT   

Chirurgia 2019 April;32(2):99-101

DOI: 10.23736/S0394-9508.18.04815-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Delayed obstructive hydrocephalus from intraventricular hemorrhage in a patient with concomitant deep vein thrombosis and occult cancer

Yusuke S. HORI ✉, Yuki EBISUDANI, Mizuho AOI, Toru FUKUHARA

Department of Neurological Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan

Delayed obstructive hydrocephalus after intraventricular hemorrhage is a rare condition whose clinical course and radiographic findings have been described in only a few reports. To date, no risk factor for the development of this disorder has been identified. A 73-year-old man was admitted to our department with left basal ganglia and intraventricular hemorrhage. He was treated conservatively without deterioration, but on day 4 his level of consciousness rapidly worsened and was accompanied by 1-day-long mild fever. Whole-body enhanced computed tomography revealed delayed obstructive hydrocephalus, concomitant deep vein thrombosis, and a potentially malignant lesion in his right lung. After external ventricular drainage the patient’s condition improved. Coagulation impairment was suspected, but extensive coagulation studies, including the determination of antithrombin III, complements, protein C and S activities, and autoimmune antibody levels, indicated no apparent causative conditions. However, transbronchial lung biopsy of the pathological lesion in his right lung led to the diagnosis of lung adenocarcinoma. The findings in this patient suggest a possibility that coagulation impairment, such as develops in association with a malignant tumor, leads to the formation of unstable hematoma and thus to delayed obstructive hydrocephalus. The possible cause of coagulation impairment, including occult cancer, should be considered in patients with delayed obstructive hydrocephalus arising from intraventricular hemorrhage.

KEY WORDS: Neoplasms - Vein thrombosis - Hydrocephalus - Cerebral intraventricular hemorrhage