Extra-Dural Hematoma in a Hydrocephalus Patient with a Dysfunctional Shunt: Therapeutic Challenge

The authors report a rare case of epidural hematoma occurred and hydrocephalus following a violent head trauma in a patient of 17 years old. The patient had received at the age of 6 months a ventriculoperitoneal shunt for triventricular hydrocephalus. Three months before the last injury he had accidentally broken his valve without any clinical manifestation. An external ventricular drain to deal with hydrocephalus was decided before the non-surgical nature of the epidural hematoma. It was followed by an increase in the volume of epidural hematoma. This necessitated an evacuation associated with a decrease in the flow rate of CFS in the pouch. 48 hours after this action, the extradural hematoma is reconstituted so as hydrocephalus that required discharge of the hematoma and increased flow rate of CSF. After stabilization, internalization of the valve has been made. Brain CT scan showed normal sized ventricles and lack of hematoma. The magnetic resonance imaging (MRI) has objectified diffuse axonal injury. Two years later, the patient presented GOS 3. We discuss what to do facing this association epidural hematoma, posttraumatic hydrocephalus in a stabilized hydrocephalus patient who broke his valve and the seesaw phenomenon that entails.