Hyperacute epidural hematoma following ventriculoperitoneal shunt placement: A fatal case presentation and discussion of management strategies.

ABSTRACT

INTRODUCTION: An Epidural hematoma following a Ventriculoperitoneal shunt is a critically rare complication. Due to that rarity and potential dangers, we present a case where the patient became symptomatic 8 h after shunting requiring craniotomy for evacuation of the hematoma. The literature and treatment options were discussed. CASE PRESENTATION A 40-year-old male arrived to the emergency department in a comatose state with dilated pupils, 8 h post-ventriculoperitoneal shunt placement. Computed tomography showed a massive hyperacute epidural hematoma causing severe midline deviation and subfalcine herniation, leading to emergency craniotomy. Despite surgical intervention and intensive care, the patient's condition did not improve, resulting in his death. DISCUSSION: Epidural hematomas (EDHs) are an infrequent complication of ventricular drainage procedures, occurring at a documented frequency of 0.4 %, often presenting with symptoms mimicking shunt malfunction or mass lesions. Diagnosis involves computed tomography (CT) scans, but magnetic resonance imaging (MRI) may be more sensitive. Treatment options include conservative management and surgical intervention, with prognosis heavily dependent on the patient's neurological status at the time of surgery, with mortality rates varying based on level of consciousness. CONCLUSION: This study presents a rare case of fatal hyperacute epidural hematoma following Ventriculoperitoneal shunt (VPS) placement in a 40-year-old man, highlighting the importance of early detection and intervention. The hypotheses suggests overloaded pressure on the dura during ventricular end insertion. Despite available treatment options, patient prognosis depends on neurological status at the time of surgery, emphasizing the need for further research into effective management strategies for this complication.