Subdural haematoma after the treatment of chronic hydrocephalus by ventriculocaval shunts.

An extradural or subdural haematoma may occur after lumbar air-encephalography or ventriculography (Khalifeh, van Allen, and Sahs, 1964; Calkins, van Allen, and Sahs, 1967), after ventricular drainage (Haft, Liss, and Mount, 1960), and after administration of intravenous urea (Marshall and Hinman, 1962). The development of a subdural haematoma after the insertion of a ventriculocaval shunt for the relief of hydrocephalus has been reported only occasionally. Foltz and Shurtleff (1963) mention one case and Horwitz and Rizzoli (1967) mention another. Forrest and Cooper (1968) describe briefly two cases of massive subdural haematoma which occurred after shunting in patients with large rigid skulls and thin cerebral cortex. Becker and Nulsen (1968) mention that seven subdural haematomas occurred in their series of 140 patients treated by shunts. However, most of these occurred in infants and none of the cases are described in any detail. The factor common to these procedures appears to be the sudden reduction of intracranial pressure which results in bleeding into the subdural space, though trauma, which can be minor, may be responsible in some instances.