Low-pressure Hydrocephalic State Complicating Hemispherectomy: A Case Report

Summary: Low-pressure hydrocephalic state (LPHS) has only recently been described as a distinct clinical entity occurring in patients with bioatrophic lesions of the brain. We report a patient in whom this syndrome developed after subtotal hemispherectomy for intractable epilepsy.

Methods: A 30-year-old man developed cerebrospinal fluid (CSF) rhinorrhea after subtotal hemispherectomy. After repair of the CSF dural fistula, clinical and radiological features of an LPHS developed. After external ventricular drainage for 26 days, a programmable low-pressure shunt system was instituted.

Results: Worsening neurologic status and ventriculomegaly in the face of normal intraventricular pressures is diagnostic of this condition. The clinical status clearly correlated with ventricular size and not ventricular pressure.

Conclusion: LPHS is a clinically significant perioperative complication that rarely occurs after large brain excisions. Restoration of the baseline brain compliance is critical in the management of this condition.