Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH)

Mark G. Hamilton, Angel V. Price

Research output: Chapter in Book/Report/Conference proceedingChapter

16 Citations (Scopus)

Abstract

Most patients with acute hydrocephalus have ventriculomegaly and high intracranial pressure (ICP). However, there is a subset of patients who are symptomatic with acute ventriculomegaly and inappropriately low ICP. Methods: Two patient groups were defined. Each patient presented with clinical deterioration that included a significant decrease in level of consciousness with new and significant ventriculomegaly. Patients in group 1 (n = 10) were managed without endoscopic third ventriculostomy (ETV). Group 2 was a series of patients (n = 10) managed with ETV. Results: Treatment for both groups involved insertion of an external ventricular drain (EVD) with ICP <5 cmH 2O. Further treatment consisted of either neck wrapping with a tensor bandage and/or lowering the EVD to negative levels to facilitate drainage of cerebrospinal fluid (CSF), which resulted in clinical improvement and resolution of ventriculomegaly. All 20 patients had anatomical obstruction to CSF flow into the subarachnoid space (SAS) confirmed by magnetic resonance imaging (MRI) with cine MRI studies. Group 1 patients were treated until shunt revision/insertion was possible (n = 7), ICP normalized, and the EVD could be removed (n = 2), or death (n = 1) occurred. Patients in group 2 all underwent ETV, and ICP patterns normalized in all. Group 2 patients were managed with an EVD until shunt revision/insertion was required (n = 2), ICP normalized and the EVD could be removed (n = 7), or death (n = 1) occurred. Discussion/Conclusions: The syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH) is an important entity in both children and adults. A possible hypothesis invokes loss of an effective SAS. ETV reestablishes communication between the SAS and ventricles, producing a rapid return of normal ICP dynamics and a significant decrease in the number of shunt-dependant patients.

Original languageEnglish (US)
Title of host publicationActa Neurochirurgica, Supplementum
Pages155-159
Number of pages5
Edition113
DOIs
StatePublished - 2012

Publication series

NameActa Neurochirurgica, Supplementum
Number113
ISSN (Print)00651419
ISSN (Electronic)00016268

Fingerprint

Hydrocephalus
Intracranial Pressure
Pressure
Ventriculostomy
Subarachnoid Space
Cine Magnetic Resonance Imaging
Bandages
Consciousness
Cerebrospinal Fluid
Neck
Communication
Magnetic Resonance Imaging

Keywords

  • ETV
  • Hydrocephalus
  • Inappropriate low-pressure hydrocephalus
  • Negative pressure
  • SILPAH
  • Third ventriculostomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Hamilton, M. G., & Price, A. V. (2012). Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH). In Acta Neurochirurgica, Supplementum (113 ed., pp. 155-159). (Acta Neurochirurgica, Supplementum; No. 113). https://doi.org/10.1007/978-3-7091-0923-6_31

Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH). / Hamilton, Mark G.; Price, Angel V.

Acta Neurochirurgica, Supplementum. 113. ed. 2012. p. 155-159 (Acta Neurochirurgica, Supplementum; No. 113).

Research output: Chapter in Book/Report/Conference proceedingChapter

Hamilton, MG & Price, AV 2012, Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH). in Acta Neurochirurgica, Supplementum. 113 edn, Acta Neurochirurgica, Supplementum, no. 113, pp. 155-159. https://doi.org/10.1007/978-3-7091-0923-6_31
Hamilton MG, Price AV. Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH). In Acta Neurochirurgica, Supplementum. 113 ed. 2012. p. 155-159. (Acta Neurochirurgica, Supplementum; 113). https://doi.org/10.1007/978-3-7091-0923-6_31
Hamilton, Mark G. ; Price, Angel V. / Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH). Acta Neurochirurgica, Supplementum. 113. ed. 2012. pp. 155-159 (Acta Neurochirurgica, Supplementum; 113).
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