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June 2022; 12 (3) Clinical/Scientific Note

Unusual Post–COVID-19 Presentation With Tetraventricular Hydrocephalus

A Case Report

Chetan Saini, Ghaida Khalaf Zaid, Leila Gachechiladze, Rashi Krishnan
First published April 21, 2022, DOI: https://doi.org/10.1212/CPJ.0000000000001174
Chetan Saini
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.
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Ghaida Khalaf Zaid
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.
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Leila Gachechiladze
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.
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Rashi Krishnan
Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.
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Citation
Unusual Post–COVID-19 Presentation With Tetraventricular Hydrocephalus
A Case Report
Chetan Saini, Ghaida Khalaf Zaid, Leila Gachechiladze, Rashi Krishnan
Neurol Clin Pract Jun 2022, 12 (3) e25-e27; DOI: 10.1212/CPJ.0000000000001174

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Abstract

Objective COVID-19 infection is suggested as one of the causes for hydrocephalus (HCP) of unknown etiology. COVID-19 infection may present with a range of neurologic symptoms given viral neurotropic and neuroinvasive properties. Postinfectious HCP is a severe complication as a potential sequela of COVID-19 infection.

Methods We identified a patient with a history of recent COVID-19 infection who presented with chronic progressive headaches with nausea, vomiting, and blurry vision over 2 weeks.

Results Neurologic examination showed bilateral papilledema. The head CT scan showed tetraventricular enlargement and marked fourth ventricular dilation. Cine MRI showed fourth ventricular turbulent CSF flow. The patient underwent external ventricular drain placement and exploratory suboccipital craniotomy, which revealed a subarachnoid web that was microsurgically resected. Reconstituted CSF flow resolved the patient's symptoms and prevented complications.

Discussion Fourth ventricular outlet obstruction is a rare cause of tetraventricular HCP. In most cases, it is associated with a history of inflammatory conditions or hemorrhage. In our case, a history of recent COVID-19 infection and normal imaging before COVID-19 make COVID-19 the most probable explanation for HCP. We suggest considering COVID-19 infection in the differential diagnosis of HCP of unclear etiology.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • NPub.org/COVID19

  • Received October 6, 2021.
  • Accepted March 3, 2022.
  • © 2022 American Academy of Neurology
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