[Significant clinical improvement in a 69-year-old patient with a disorder of cerebrospinal fluid drainage following implantation of a Holter-Hausner shunt 9 months after a type III concussion].

We report on a 69-year-old woman who had suffered a serious closed brain injury with 3rd degree contusion and who had again suffered, after a heavily prolonged course with an initial clinical improvement, from excessive neuropsychological deterioration. Contrary to slight signs of internal hydrocephalus in CT fluid scintigraphy showed distinct signs of fluid passage disturbances according to occlusive hydrocephalus. Despite serious neurosurgical doubts (age, distance to trauma, slight extension of CT-findings) a Holter-Hausner-valve was finally applied, which resulted in a good motor and neuropsychological improvement. The case may be used as an example of the fact that elderly patients, especially, cannot be judged by general experience, but each patient's case should be discussed individually. From the point of view of rehabilitation, neuropsychological symptoms, especially the course of the vigilance level, should be significant in making decisions.