A case of suspected low-pressure hydrocephalus caused by spinal drainage following subarachnoid hemorrhage

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Background: Hydrocephalus induced by low cerebrospinal fluid (CSF) pressure is extremely rare and sporadically reported. Subarachnoid hemorrhage, head trauma, and spinal drainage were reported to be the causative factors for surgical treatments.

Case Description: A 33-year-old male with subarachnoid hemorrhage caused by right vertebral artery aneurysm rupture developed a headache. A trapping surgery was performed, and a spinal drain was inserted from the lumbar L4/5 for subarachnoid hemorrhage washout. On postoperative day 3, increase in subdural fluid accumulation at the posterior fossa craniotomy site and narrowing of the cerebellar sulci appeared in addition to mild enlargement of the ventricles. The patient complained of a headache during head elevation. Low-pressure hydrocephalus (LPH) was suspected. The spinal drain was removed, the headache was relieved, and cerebral ventriculomegaly disappeared. The subsequent clinical course was good. The patient was discharged 3 weeks after the surgery.

Discussion: LPH is a rare disease caused by various factors and is treated by correcting liquorrhea or overdrainage, if any. Otherwise, drainage at a negative CSF pressure is necessary. Its symptoms and image findings are similar to those of intracranial hypertension and normal-pressure hydrocephalus. This paper reports a suspected LPH case caused by spinal drainage following subarachnoid hemorrhage with literature review.