Malpositioned extraventricular drain

Case contributed by Alberto Nania
Diagnosis certain


Admitted following subarachnoid hemorrhage. Ventricular drain inserted to decompress hydrocephalus but persistent reduced GCS ?cause

Patient Data

Age: 70
Gender: Male

Hydrocephalus, intraparenchymal and intraventricular hemorrhage.

The EVD tract is hyperdense but this is from blood. The EVD itself lies extracranially, with tip located in a large right frontal subgaleal collection.

Left cerebellar hematoma and small volume post-surgical pneumocephalus are also noted.

Case Discussion

This patient underwent external ventricular drain (EVD) insertion due to hydrocephalus, developed as a complication of SAH. The EVD was dislodged, with acute hemorrhage visible through the intracranial tract and the drain tip located in a subgaleal collection.

It is important to review the imaging on multiple planes and windows, and to bear in mind that intracranial drains should always be well visible on CT. Clinically, the EVD was patent and working, but draining a subgaleal collection rather than CSF.

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