Hydrocephalus is a rare complication of traumatic spine injury. A literature review of hydrocephalus in traumatic spine injury reflects the rare occurrence with cervical spine injury. In the spinal cord tumor literature, distal thoracolumbar tumors are known to cause hydrocephalus. In our literature review, there have been no published cases or reviews of a traumatic injury distal to the cervical spine causing hydrocephalus. We present a case of traumatic injury to the lumbar spine from a gunshot wound which caused communicating hydrocephalus.
The patient sustained a gunshot wound to the lumbar spine and had an L4-5 laminectomy with exploration and removal of foreign bodies. At the time of surgery, the patient was found to have dense subarachnoid hemorrhage in the spinal column. He subsequently had intermittent headaches and altered mental status that resolved without intervention. Workup of the headaches for infection including lumbar tap was performed which revealed no growth. The patient was discharged to an acute rehabilitation facility and had followup 20 days later. Follow up CT of the lumbar spine was significant for interim development of a traumatic lumbar pseudomeningocele. The intermittent headaches had been worsening while in rehabilitation so a CT Brain was performed which revealed hydrocephalus and the patient was emergently transferred to the neurosurgery service. IR-guided cervical spinal tap was performed that again did not demonstrate meningitis. A ventricle peritoneal shunt was placed and repeat CT Brain showed reduced ventricle size. The patient returned to rehabilitation with complete resolution of hydrocephalus symptoms.
Conclusion: Remote subarachnoid hemorrhage with subsequent arachnoiditis causing obstruction at the level of the arachnoid granulations was thought to lead to communicating hydrocephalus in this case of lumbar spine penetrating trauma. Hydrocephalus should be on the headache and/or altered mental status differential in a bloody, traumatic spinal injury.