Acute obstructive hydrocephalus due to a small clot cast in the aqueduct following a minor caudate hemorrhage

Abstract

Background: Although acute obstructive hydrocephalus secondary to intraventricular hemorrhage is relatively common, acute obstructive hydrocephalus following a minor hemorrhagic stroke is a rare entity. We present a case of acute aqueduct obstruction caused by a small caudate hemorrhage with intraventricular extension. Case presentation: An 85-year-old previously independent man presented with sudden onset of consciousness disturbance, and became comatose within 5 h after the onset. A computed tomography scan showed symmetric dilatation of the lateral and third ventricles with a small high-density area in the head of the left caudate nucleus and the aqueduct. Sagittal fast imaging employing steady-state acquisition magnetic resonance imaging obtained on admission demonstrated aqueductal obstruction and ballooning of the third ventricle. Based on the clinical course and radiological images, the patient was diagnosed with acute obstructive hydrocephalus due to aqueductal obstruction by the migrated clot fragment. The patient underwent external ventricular drainage immediately after the diagnosis on the day of admission. Following the drainage, his consciousness disturbance gradually improved. The patient was transferred for rehabilitation with a modified Rankin scale score of 4 and had no recurrence of hydrocephalus over the following 8 months. Conclusion: The occurrence of acute aqueductal obstruction, albeit a small amount of intraventricular hemorrhage, should be considered when a patient presents with sudden onset of consciousness disturbance.

Keywords

• Obstructive hydrocephalus
• Minor intraventricular hemorrhage
• Aqueductal obstruction