1325. Post-traumatic Hydrocephalus Associated With Occipitocervical Ligamentous Injury

Authors: Muhammad Burhan Ud Din Janjua, MD; Dale Swift, MD; Brett Whittemore, MD (Dallas, TX)

Introduction:

Post-traumatic hydrocephalus can be a complication of trauma of occipitocervical region. There are very few case reports in an adult population; however, no case has been reported in pediatrics. Authors propose that fourth ventricular outflow obstruction due to subarachnoid hemorrhage as well as direct epidural compression at the craniocervical junction are likely involved etiologies.

Methods:

Two cases of ligamentous trauma at the occipitocervical junction presenting to a tertiary care trauma center were successfully treated with external cervical orthoses. Detailed CT and MR imaging of the brain and cervical spine revealed ligamentous injury of the occipitocervical region and progressive hydrocephalus.

Results:

The authors present a case series of 2 male pediatric cases with a unique pathogenesis and presentation of post-traumatic hydrocephalus in the setting of occipitocervical ligamentous injury. A large retroclival epidural hematoma caused acute obstructive hydrocephalus in 6 year old, which resolved after treatment with an external ventricular drain that was ultimately weaned and removed. Focal subarachnoid hemorrhage in the cisterna magna at the fourth ventricle outflow in a 2 year old patient resulted in the subacute development of hydrocephalus over the ensuing weeks, and was successfully treated with an endoscopic third ventriculostomy. Direct compression of the spinal venous plexus or ventricular outflow obstruction are likely etiologies for these cases of post-traumatic hydrocephalus. Both patients did well without functional limitation or recurrence of hydrocephalus.

Conclusion:

Post-traumatic hydrocephalus can be a sequela of ligamentous injury at the occipitocervical junction. This rare presentation can be effectively treated with CSF diversion.