Article

OBJECTIVE: To investigate the impact of ventriculoperitoneal shunting during
clinical rehabilitation of chronic normal pressure hydrocephalus patients with
disorders of consciousness following aneurysmal subarachnoid haemorrhage.
DESIGN: Cross-sectional study.
METHODS: Thirty-five patients with disorders
of consciousness following aneurysmal subarachnoid haemorrhage who had undergone
ventriculoperitoneal shunting for chronic normal pressure hydrocephalus were
compared with 16 matched controls with no ventriculoperitoneal shunting. Data
from clinical examinations, rehabilitation assessments and computed tomography
scans (to exclude other diseases that can cause ventricular enlargement) were
analysed. All the patients with disorders of consciousness underwent
neurorehabilitation. Consciousness was measured on the Glasgow Coma Scale. The
cella media index was calculated as the change in size of the lateral ventricles
(prior to ventriculoperitoneal shunting and/or rehabilitation, and 1 and 3 months
after shunting and/or rehabilitation). The short-term outcome of treatment was
assessed at 3 months using the Glasgow Outcome Scale.
RESULTS: Twenty-four out of
35 patients with disorders of consciousness recovered gradually after
ventriculoperitoneal shunting and rehabilitation. There was a significant
difference in the Glasgow Coma Scale between ventriculoperitoneal shunting and
control groups at both 1 and 3 months (F = 19.29, p < 0.01). Significant
differences were also observed between the 2 groups in the cella media index at 1
and 3 months (F = 15.03, p < 0.01). The Glasgow Outcome Scale of the
ventriculoperitoneal shunting group was significantly higher than that of the
control group (p < 0.01, r = 0.55) 3 months after shunting and/or rehabilitation.
CONCLUSION: Chronic normal pressure hydrocephalus during rehabilitation is a
serious and previously unrecognized medical condition, which influences
consciousness in patients following an aneurysmal subarachnoid haemorrhage.
However, the condition can be treated by ventriculoperitoneal shunting, which
helps some patients with disorders of consciousness to regain consciousness.

Langue : ANGLAIS