The Patient with Hydrocephalus

  • Ross A. Malley


A 75-year-old woman with a history of a large subfrontal lobe meningioma and new-onset seizure disorder was admitted for surgical resection of the lesion. Past medical history was significant for obesity, questionable history of congestive heart failure (CHF) without known myocardial infarction, and hypertension. Medications on admission included phenytoin 300 mg b.i.d., propranolol 20 mg t.i.d., and hydrochlorothiazide 50 mg q.d.

The patient underwent an uneventful bifrontal craniotomy with complete resection of the meningioma. Her postoperative course was complicated by evidence of worsening CHF with subjective dyspnea, bibasilar râles, increased vascular pattern on chest x-ray, and PaO2 of 55 mmHg on room air. The patient had also developed a persistent cerebrospinal fluid rhinorrhea that did not respond to lumbar draining. A head CT scan demonstrated enlarged ventricles and edema in the area of tumor resection. A diagnosis of communicating hydrocephalus was made, and the patient was scheduled for insertion of ventriculoperitoneal shunt.


Cerebral Blood Flow Fourth Ventricle Aqueductal Stenosis Normal Pressure Hydrocephalus Abducens Nerve Palsy 
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© Birkhäuser Boston Inc. 1989

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  • Ross A. Malley

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