Large intracranial hemorrhage with malpositioned external ventricular drain

Case contributed by Henry Knipe


Loss of consciousness

Patient Data

Age: 50 years
Gender: Female

Left frontal EVD with the tip within white matter (i.e. not intraventricular). Linear hemorrhage in the left frontal lobe and left basal ganglia is new. Large right parenchymal hemorrhage centered on the right basal ganglia extending to involve the right thalamus results in midline shift to the left of 8 mm (previously 10 mm).

Intraventricular hemorrhage to the level of the fourth ventricle resulting in mild obstructive hydrocephalus. There is some subarachnoid extension on the right through the Sylvian fissure.

Case Discussion

The tip lies within white matter, not within the lateral ventricles. This means the drain is non-therapeutic and requires repositioning otherwise the obstructive hydrocephalus will worsen. 

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