Post-infective Hydrocephalus

  • Sandip ChatterjeeEmail author
Living reference work entry


Hydrocephalus which occurs after pyogenic or chronic infections of the brain is called “post-infective” hydrocephalus. Escherichia coli, group B streptococci, and Haemophilus and Neisseria meningitidis may be the causative organisms responsible for pyogenic meningitis in different age groups, and hydrocephalus follows the development of inflammatory exudates in the basal cisterns. In post-tubercular hydrocephalus, it is the fibrosis in the healing stage that is responsible for occlusion of the arachnoid villi and cerebrospinal fluid pathways. Hydrocephalus can also occur after prenatal infections like after toxoplasmosis or cytomegalovirus infections. Rarely hydrocephalus may occur after mycotic or viral infections of the brain. Whereas in post-infective hydrocephalus, the CSF is rendered sterile while a temporizing procedure like a ventriculo-subgaleal shunt may be performed, in the post-tubercular hydrocephalus, it is necessary to ascertain the level of intraventricular pressure before deciding on a diversion procedure, either by an endoscopic third ventriculostomy or a ventriculoperitoneal shunt.


Hydrocephalus Post-meningitic Shunt Tuberculous 


  1. al-Ali HY, Yasseen SA, Raof TY (1999) Follow-up of pregnant women with active cytomegalovirus infection. East Mediterr Health J 5(5):949–954PubMedGoogle Scholar
  2. Alonso A, Alvarez A, Seara MJ, Linares M, Villalon J (1996) Unusual manifestations of postnatally acquired cytomegalovirus infection: findings on CT and MR. Pediatr Radiol 26(11):772–774CrossRefPubMedGoogle Scholar
  3. Andreula CF, Burdi N, Carella A (1993) CNS cryptococcosis in AIDS: spectrum of MR findings. J Comput Assist Tomogr 17:438–441CrossRefPubMedGoogle Scholar
  4. Arsura EL, Kilgore WB, Caldwell JW et al (1998) Association between facial cutaneous coccidioidomycosis and meningitis. West J Med 169:13–16PubMedPubMedCentralGoogle Scholar
  5. Arumugasamy N (1985) Intracerebral cryptococcomas. Ann Acad Med Singap 14:16–21PubMedGoogle Scholar
  6. Bale JF Jr, Reiley TT, Bray PF et al (1980) Cytomegalovirus and dual infection in infants. Arch Neurol 37(4):236–238CrossRefPubMedGoogle Scholar
  7. Barkovich AJ, Girard N (2003) Fetal brain infections. Childs Nerv Syst 19:501–511CrossRefPubMedGoogle Scholar
  8. Bouza E, Dreyer JS, Hewitt WL et al (1981) Coccidioidal meningitis: an analysis of 31 cases and review of literature. Medicine (Baltimore) 60(3):139–172CrossRefGoogle Scholar
  9. Bray PF, Bale JF, Anderson RE et al (1981) Progressive neurological disease associated with chronic cytomegalovirus infection. Ann Neurol 9(5):499–502CrossRefPubMedGoogle Scholar
  10. Brogi E, Cibas ES (2000) Cytologic detection of Toxoplasma gondii tachyzoites in cerebrospinal fluid. Am I Clin Pathol 114:951–955CrossRefGoogle Scholar
  11. Cardia E, Molina D, Abbate F et al (1995) Morphological modifications of the choroid plexus in a rodent model of acute ventriculitis induced by gram-negative liquoral sepsis. Possible implications in the pathophysiology of hypersecretory hydrocephalus. Childs Nerv Syst 11(9):511–516CrossRefPubMedGoogle Scholar
  12. Chen SC (2002) Cryptococcosis in Australasia and the treatment of cryptococcal and other fungal infections with liposomal amphotericin B. I Antimicrob Chemother 49(Suppl A):57–61CrossRefGoogle Scholar
  13. Cinalli G, Sainte-Rose C, Chumas P et al (1999) Failure of third ventriculostomy in the treatment of aqueductal stenosis in children. J Neurosurg 90:448–454CrossRefPubMedGoogle Scholar
  14. Cipri S, Gambardella G (2001) Neuroendoscopic approach to complex hydrocephalus. Personal experience and preliminary report. J Neurosurg Sci 45:92–96PubMedGoogle Scholar
  15. Conly JM, Ronald AR (1983) Cerebrospinal fluid as a diagnostic body fluid. Am J Med 75(1B): 102–108CrossRefPubMedGoogle Scholar
  16. Corti M, Priarone M, Negroni R et al (2014) Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly. Rev Soc Bras Med Trop 47(4):524–527. PubMed PMID: 25229298CrossRefPubMedGoogle Scholar
  17. Couvreur J, Desmonts G: Toxoplasmosis. Vinken PJ, Bruyn GW Handbook of clinical neurology, 35. North Holland, Amsterdam, 115–141, 1978Google Scholar
  18. Dastur DK, Manghani DK, Udani PM (1995) Pathology and pathogenetic mechanisms in neurotuberculosis. Radiol Clin N Am 33:733–752PubMedGoogle Scholar
  19. Doctor BA, Newman N, Minich NM et al (2001) Clinical outcomes of neonatal meningitis in very-low birth-weight infant. Clin Pediatr (Phila) 40(9):473–480CrossRefGoogle Scholar
  20. Doherty RL, Jordan MC (1989) Viral meningoencephalitis. In: Hoeprich PD, Jordan MC (eds) Infectious diseases, 4th edn. Lippincott, Philadelphia, pp 1098–1108Google Scholar
  21. Erly WK, Bellon RJ, Seeger JF et al (1999) MR imaging of acute coccidioidal meningitis. AJNR Am J Neuroradiol 20:509–514PubMedGoogle Scholar
  22. Falangola MF, Petito CK (1993) Choroid plexus infection in cerebral toxoplasmosis in AIDS patients. Neurology 43:2035–2040CrossRefPubMedGoogle Scholar
  23. Fessler RD, Sobel J, Guyot L et al (1998) Management of elevated intracranial pressure in patients with cryptococcal meningitis. I Acquir Immune Defic Syndr Hum Retrovirol 17:137–142CrossRefGoogle Scholar
  24. Fishman RA (1992) Cerebrospinal fluid in diseases of the nervous system, 2nd edn. Saunders, PhiladelphiaGoogle Scholar
  25. Foulon W, Naessens A, Ho-Yen D (2000) Prevention of congenital toxoplasmosis. J Perinat Med 28(5):337–345CrossRefPubMedGoogle Scholar
  26. Fries BC, Lee SC, Kennan R et al (2005) Phenotypic switching of Cryptococcus neoformans can produce variants that elicit increased intracranial pressure in a rat model of cryptococcal meningoencephalitis. Infect Immun 73:1779–1787CrossRefPubMedPubMedCentralGoogle Scholar
  27. Fritsch M, Manwaring KH (1997) Endoscopic treatment of brain abscess in children. Minim Invasive Neurosurg 40(3):103–106. PubMed PMID: 9359089CrossRefPubMedGoogle Scholar
  28. Fujita NK, Reynard M, Sapico FL et al (1981) Cryptococcal intracerebral mass lesions: the role of computed tomography and nonsurgical management. Ann Intern Med 94:382–388CrossRefPubMedGoogle Scholar
  29. Gagne SS (2001) Toxoplasmosis. Prim Care Updat Ob Gyns 8(3):122–126CrossRefGoogle Scholar
  30. Galgiani IN, Peng T, Lewis ML et al (1996) Cerebrospinal fluid antibodies detected by ELISA against a 33-kDa antigen from spherules of Coccidioides immitis in patients with coccidioidal meningitis. The National Institute of Allergy and Infectious Diseases Mycoses Study Group. J Infect Dis 173:499–502CrossRefPubMedGoogle Scholar
  31. Goel A (2004) Tuberculous meningitis and hydrocephalus. Neurol India 54(2):155Google Scholar
  32. Gomes I, Melo A, Lucena R et al (1996) Prognosis of bacterial meningitis in children. Arq Neuropsiquiatr 54(3):407–411CrossRefPubMedGoogle Scholar
  33. Gumbo T, Kadzirange G, Mielke J et al (2002) Cryptococcus neoformans meningoencephalitis in African children with acquired immunodeficiency syndrome. Pediatr Infect Dis J 21:54–56CrossRefPubMedGoogle Scholar
  34. Handler LC, Wright MG (1978) Postmeningitic hydrocephalus in infancy. Ventriculography with special reference to ventricular septa. Neuroradiology 16:31–35CrossRefPubMedGoogle Scholar
  35. Hardesty DA, Ramey W, Afrasiabi M et al (2014) Patient outcomes and surgical complications in coccidioidomycosis-related hydrocephalus: an institutional review. J Neurosurg 121(4): 785–789. Epub 2014 Jul 25. PubMed PMID: 25061867CrossRefPubMedGoogle Scholar
  36. Hayward JC, Titelbaum DS, Clancy RR et al (1991) Lissencephaly-pacygyria associated with congenital cytomegalovirus infection. Child Neurol 6(2):109–114CrossRefGoogle Scholar
  37. Hospenthal DR, Bennett JE (2000) Persistence of cryptococcomas on neuroimaging. Clin Infect Dis 31:1303–1306CrossRefPubMedGoogle Scholar
  38. Hower J, Clar HE, Duchting M (1972) Mumps as a cause of hydrocephalus. Pediatrics 50:346–347PubMedGoogle Scholar
  39. Jellinger G (1986) Anatomopathology of nontumoral aqueductal stenosis. J Neurosurg Sci 30:1–16PubMedGoogle Scholar
  40. Jha DK, Vineeta M, Ajay C et al (2007) Factors affecting the outcome of neuroendoscopy in patients with tuberculous meningitis hydrocephalus: a preliminary study. Surg Neurol 68(1): 35–41CrossRefPubMedGoogle Scholar
  41. Jordan C (1989) In: Hoeprich PD, Jordan MC (eds) Infectious disease, 4th edn. JB Lippincott Company, Philadelphia/Grand Rapids/New York/St. Louis/San Francisco/London/Sydney/Tokyo, pp 805–811Google Scholar
  42. Kaiser G (1985) Hydrocephalus following toxoplasmosis. Z Kinderchir 40(Suppl 1):10–11PubMedGoogle Scholar
  43. Knoper SR, Galgiani IN (1988) Systemic fungal infections: diagnosis and treatment. 1. Coccidioidomycosis. Infect Dis Clin N Am 2:861–875Google Scholar
  44. Lapierre J, Tourte-Schaefer C, Heyer F et al (1983) Congenital toxoplasmosis. Remarks apropos of serologic surveillance in 15,000 pregnant women. Sem Hop 59(40):2741–2745PubMedGoogle Scholar
  45. Lee WS, Puthucheary SD, Omar A (1999) Salmonella meningitis and its complications in infants. J Paediatr Child Health 35(4):379–382CrossRefPubMedGoogle Scholar
  46. Li L, Padi A, Ranjeva SL, Donaldson S et al (2011) Association of bacteria with hydrocephalus in Ugandan infants. J Neurosurg Paediatrics 7:73–87CrossRefGoogle Scholar
  47. Lorber J, Pickering D (1966) Incidence and treatment of post-meningitic hydrocephalus in the newborn. Arch Dis Child 41:44–50CrossRefPubMedPubMedCentralGoogle Scholar
  48. Luft BJ, Remington JS (1989) Toxoplasmosis. In: Hoeprich PD, Jordan MC (eds) Infectious disease, 4th edn. JB Lippincott Company, Philadelphia, pp 1199–1214Google Scholar
  49. Mahajan KR, Roberts AL, Curtis MT et al (2016) Diagnostic challenges of Cryptococcus neoformans in an immunocompetent individual masquerading as chronic hydrocephalus. Case Rep Neurol Med 2016:7381943. Epub 2016 Jul 20CrossRefPubMedPubMedCentralGoogle Scholar
  50. Manz HJ, Schuelein M, McCullough DC et al (1980) New phenotypic variant of adrenoleukodystrophy. Pathologic, ultrastructural, and biochemical study in two brothers. J Neurol Sci 45(2–3): 245–260CrossRefPubMedGoogle Scholar
  51. Mathew JM, Rajsekhar V, Chandy MJ (1998) Shunt surgery in poor grade patients with tuberculous meningitis and hydrocephalus: effects of response to external ventricular drainage and other variables on long-term outcome. J Neurol Neurosurg Psychiatry 65:115–119CrossRefPubMedPubMedCentralGoogle Scholar
  52. Matsumoto N, Yano S, Miyao M et al (1983) Two-dimensional ultrasonography of the brain: its diagnostic usefullness in herpes simplex encephalitis and cytomegalic inclusion disease. Brain Dev 5(3):327–333CrossRefPubMedGoogle Scholar
  53. Meenken C, Assies J, van Nieuwenhuizen O et al (1995) Long term ocular and neurological involvement in severe congenital toxoplasmosis. Br J OphthalmoI 79:581–584CrossRefGoogle Scholar
  54. Morgenlander JC (1994) Lumbar puncture and CSF examination. Postgrad Med 95(8):125–131CrossRefPubMedGoogle Scholar
  55. Oi S, Abbott R (2004) Loculated ventricles and isolated compartments in hydrocephalus: their pathophysiology and the efficacy of neuroendoscopic surgery. Neurosurg Clin N Am 15:77–87CrossRefPubMedGoogle Scholar
  56. Overturf GD (1989) Bacterial meningitis. In: Hoeprich PD, Jordan MC (eds) Infectious disease, 4th edn. JB Lippincott Company, Philadelphia/Grand Rapids/New York/St. Louis/San Francisco/London/Sydney/Tokyo, pp 1114–1132Google Scholar
  57. Palur R, Rajsekhar V, Chandy MJ et al (1991) Shunt surgery for hydrocephalus in tuberculous meningitis: a long term follow-up study. J Neurosurg 74:64–69CrossRefPubMedGoogle Scholar
  58. Pappagianis D (1993) Coccidioidomycosis. Semin Dermatol 12:301–309PubMedGoogle Scholar
  59. Park MK, Hospenthal DR, Bennett JE (1999) Treatment of hydrocephalus secondary to cryptococcal meningitis by use of shunting. Clin Infect Dis 28(3):629–633CrossRefPubMedGoogle Scholar
  60. Parker KM, Nicholson JK, Cezayirli RC et al (1996) Aspergillosis of the sphenoid sinus: presentation as a pituitary mass and post-operative Gallium-67 imaging. Surg Neurol 45:354–358CrossRefPubMedGoogle Scholar
  61. Perlman JM, Argyle C (1992) Lethal cytomegalovirus infection in preterm infants: clinical, radiological, and neuropathological findings. Ann Neurol 31(1):64–68CrossRefPubMedGoogle Scholar
  62. Post MJ, Hensley GT, Moskowitz LB et al (1986) Cytomegalic inclusion virus encephalitis in patients with AIDS: CT, clinical, and pathologic correlation. AJR Am J Roentgenol 146(6):1229–1234CrossRefPubMedGoogle Scholar
  63. Prats JM, Lopez-Heredia J, Gener B et al (2001) Multilocular hydrocephalus: ultrasound studies of origin and development. Pediatr Neurol 24(2):149–151CrossRefPubMedGoogle Scholar
  64. Punt J (1993) Principles of CSF diversion and alternative treatments. In: Schurr PH, Polkey CE (eds) Hydrocephalus. Oxford Medical Publications, Oxford, pp 139–160Google Scholar
  65. Raheja H, Sinha A, Irukulla PK (2017) Cryptococcal meningitis masquerading as normal pressure hydrocephalus in an immunocompetent adult. J Glob Infect Dis 9(4):157–159CrossRefPubMedPubMedCentralGoogle Scholar
  66. Romeo JH, Rice LB, McQuarrie IG (2000) Hydrocephalus in coccidioidal meningitis: case report and review of the literature. Neurosurgery 47:773–777PubMedGoogle Scholar
  67. Rotilio A, Salar G, Dollo C et al (1985) Aqueductal stenosis following mumps infection. Case report. Ital J Neurol Sci 6:237–239CrossRefPubMedGoogle Scholar
  68. Russell DS (1949) Observations on the pathology of hydrocephalus. Medical Res Council, special report series, vol 265. His Majesty’s Stationery Office, LondonGoogle Scholar
  69. Schoeman JF, Honey EM, Loock DB (1996) Raised ICP in a child with cryptococcal meningitis: CT evidence of a distal CSF block. Childs Nerv Syst 12:568–571CrossRefPubMedGoogle Scholar
  70. Schultz P, Leeds NE (1973) Intraventricular septations complicating neonatal meningitis. J Neurosurg 38:620–626CrossRefPubMedGoogle Scholar
  71. Seehusen DA, Reeves MM, Demitri F (2003) Cerebrospinal fluid analysis. Am Fam Physician 8(6):1103–1108Google Scholar
  72. Senat MV, Bernard JP, Schwarzler P et al (1999) Prenatal diagnosis and follow-up of 14 cases of unilateral ventriculomegaly. Ultrasound Obstet GynecoI 14:327–332CrossRefGoogle Scholar
  73. Sharma R, Bahl L, Goyal A et al (1995) Congenital cytomegalovirus infection in Shimla Hills, Himachal Pradesh. India J Commun Dis 27:23–26PubMedGoogle Scholar
  74. Sil K, Chatterjee S (2008) Shunting in tuberculous meningitis: a surgeon’s nightmare. Childs Nerv Syst 24(9):1029–1032CrossRefPubMedGoogle Scholar
  75. Stahl W, Kaneda Y (1997) Pathogenesis of murine toxoplasmic hydrocephalus. Parasitology 114(Pt 3):219–229CrossRefPubMedGoogle Scholar
  76. Stoll BJ, Schuchat A (1998) Maternal carriage of group B streptococci in developing countries. Padiatr Infect Dis J 17:499–503CrossRefGoogle Scholar
  77. Takano T, Mekata Y, Yamano T et al (1993) Early ependymal changes in experimental hydrocephalus after mumps virus inoculation in hamsters. Acta Neuropathol (Berl) 85:521–525CrossRefGoogle Scholar
  78. Thwaites G, Chau TTH, Mai NTH et al (2000) Tuberculous meningitis. J Neurol Neurosurg Psychiatry 68:289–299CrossRefPubMedPubMedCentralGoogle Scholar
  79. Udani V, Udani S, Merani R et al (2003) Unrecognized ventriculitis/meningitis presenting as hydrocephalus in infancy. Indian Pediatr 40(9):870–873PubMedGoogle Scholar
  80. van Landegem FK, Stiller B, Lehmann TN et al (2000) Aqueductal stenosis and hydrocephalus in an infant due to aspergillus infection. Clin Neuropathol 19:26–29Google Scholar
  81. Warf BC (2005) Hydrocephalus in Uganda: the predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg 102(1):1–15CrossRefPubMedGoogle Scholar
  82. WHO Young Infants Sudy Group (1999) Bacterial etiology of serious infections in young infants in developing countries: results of a multicentre study. Paediatr Infect Dis 18(10 suppl):S17–S22Google Scholar
  83. Wolinsky JS (1977) Mumps virus-induced hydrocephalus in hamsters. Ultrastructure of the chronic infection. Lab Investig 37:229–236PubMedGoogle Scholar
  84. Wrobel Q, Meyer S, Johnson RH et al (1992) MR findings in acute and chronic coccidioidomycosis meningitis. AJNR Am J NeuroradioI 13:1241–1245Google Scholar
  85. Xie D, Cao H, Yu H (1999) Differential diagnosis in patients with tuberculous meningitis and cryptococcal meningitis [in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi 22:731–733PubMedGoogle Scholar
  86. Yaramis A, Gurkan F, Elevli M et al (1998) Central nervous system tuberculosis in children: a review of 214 cases. Paediatrics 102:e49CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryVivekananda Institute of Medical sciences and Park ClinicKolkataIndia

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