۱- Introduction

۲- Case Presentation

۳- Discussion

۴- Conclusions

References

Abstract

Background: Transient obstructive hydrocephalus is a rare condition. Previous case reports have described spontaneous resolution of obstructive hydrocephalus, although the entire mechanism has not yet been clarified. Case description: We report four cases of transient obstructive hydrocephalus after subarachnoid hemorrhage (2 cases) and intra-cerebral hemorrhage (2 cases) caused by obstruction of the aqueduct in patients who presented with altered consciousness that resolved soon after changing their posture from the supine to semi-prone (facedown) position. Conclusions: Face-down positioning might be beneficial for patients with delayed obstructive hydrocephalus, especially that due to a mobile hematoma in the third ventricle.

Introduction

Patients with intra-ventricular hematoma (IVH) sometimes develop obstructive hydrocephalus, which has the potential to cause severe mortality and disability [1,2]. Although cerebrospinal fluid (CSF) drainage should be considered emergently in such a situation, several previous case reports have described spontaneous resolution of obstructive hydrocephalus [3–۷]. In almost every case, the clot that had moved to the entrance of the cerebral aqueduct was suspected to disturb normal CSF flow, with subsequent exacerbation of hydrocephalus. In these reports, in the patients who developed delayed hydrocephalus after intracranial hemorrhage or subarachnoid hemorrhage (SAH) with a small amount of IVH, changing their posture from the supine to facedown (semi-prone) position was performed, in anticipation that the obstructing hematoma would move away from the entrance of the cerebral aqueduct (Fig. 1). We report an experimental single-cases study of four consecutive cases of delayed development of hydrocephalus treated at our institute from August 2016 to August 2019 that showed resolution of hydrocephalus soon after the procedure.