[Clinical observations on hydrocephalus with special regard to the posttraumatic malresorptive form (author's transl)].

100 cases of Spitz-Holter shunts performed for hydrocephalus over a period of 3 years were analyzed; 17 of these were of posttraumatic origin and are discussed in regard to pathogenesis, clinical symptoms, diagnostic methods, and therapy. Half of these 17 had severe traffic accidents. The rapidity and degree of ventricular dilatation were positively correlated with the duration of unconsciousness. When the unconsciousness had lasted more than 10 days hydrocephalus was recognized early, and the shunt was performed on an average 2 months after the trauma. Two thirds of the patients improved after the shunt operation. Pathogenetically we believe the important factors in the acute stages are increased CSF pressure, disturbed CSF dynamics, brain swelling and vascular circulation disorder; in the chronic stages, parenchymous atrophy. The following 3 types of posttraumatic hydrocephalus were differentiated on the basis of the clinical features: --symmetrical communicating internal hydrocephalus with malresorption, especially after subarachnoid hemorrhage, --communicating internal hydrocephalus alone, or in combination with external hydrocephalus resulting from atrophy, --internal occlusive hydrocephalus after trauma. The following posttraumatic clinical features were found to be indications that hydrocephalus may be present: in the acute stages inadequately long symptom resolution considering the severity of the trauma, secondary changes for the worse, an apallic syndrome which does not improve; in late stages, the presence of an Adams-Hakim syndrome charaterized by dementia, a spastic gait and loss of sphincter control. The most successful diagnostic methods were found to be pneumencephalography with 24 and 48 h delayed exposures, cisternoscintigraphy and continuous intracranial pressure monitoring in combination with the spinal infusion test. The most important intracranial shunting procedures and the indications for shunting are discussed.