MULTILOCULATED HYDROCEPHALUS RELATED TO CEREBROSPINAL-FLUID SHUNT INFECTION

This study is an attempt to establish that CSF shunt infection has a r ole in the aetiology of multiloculated hydrocephalus. The authors carr ied out a review of 12 cases of multiloculated hydrocephalus who were treated at King Khalid University Hospital between 1988-1994. The mult iloculation appears to have developed following the shunt infection in all cases. The hydrocephalus was related to an intraventricular haemo rrhage (IVH) in 9 patients and was congenital in 2 patients and post-m eningitic in 1 patient. The shunt infection was caused by a gram negat ive organism in 8 patients and duration of external ventricular draina ge ranged from 9-24 (median 13) days. The diagnosis of multiloculated hydrocephalus was made on average 2 months after the shunt infection. In three patients endoscopic fenestration of intraventricular septatio ns was attempted but was effective in only one case. The other patient s were managed by two shunts (9 patients) and three shunts (2 patients ). At a mean follow-up of 15 months, the shunt revision rate of the pa tients was 0.4/year. One patient died of multiple brain abscesses and 6 patients remain severely disabled. The poor outcome may also be rela ted to the original IVH as well as the multiloculated hydrocephalus. T he study also shows that patients with post-haemorrhagic hydrocephalus , who develop a shunt infection due to gram-negative organisms and in whom the CSF fails to be cleared of the infection following 12 days of external drainage appear to be at risk of developing multiloculated h ydrocephalus.