Traumatic and Iatrogenic Complications of Hydrocephalus and Meningitis

Neurological Complications

The American Academy of Neurology recommends that patients with obstructive hydrocephalus should be treated promptly to prevent herniation, which is a surgically treatable complication that requires immediate recognition 1
Complications of bacterial meningitis include cerebrovascular events, such as cerebral infarction, subarachnoid hemorrhage, intracerebral hemorrhage, and cerebral venous sinus thrombosis, which occur frequently during the course of the disease 1, 2
Approximately one-third of adults with bacterial meningitis develop hemodynamic or respiratory failure during their clinical course 1
Hydrocephalus occurs in 40-85% of patients with chronic meningitis, with greater severity in children than in adults 1

Patients with hydrocephalus and chronic meningitis who present with respiratory symptoms or aspiration should be considered for aspiration due to neurological dysfunction, which can cause aspiration and recurrent pneumonia 1
Respiratory symptoms in these patients are more likely secondary to brainstem compromise, herniation, or acute respiratory failure requiring mechanical ventilation 1

The priority diagnosis in patients with hydrocephalus and chronic meningitis should focus on cerebral herniation, increased intracranial pressure, and cerebrovascular complications 1, 3
External ventricular drainage is indicated in most patients with obstructive hydrocephalus to prevent cerebral herniation 1