RESUMO
BACKGROUND: Normal pressure hydrocephalus (NPH) treatment consists of using valves for drainage, as it is for hydrocephalus in general. Despite this, complications can occur, putting the patient at risk, and neurological monitoring is crucial. OBSERVATIONS: A 61-year-old male, who had been diagnosed with NPH 3 years prior and was being treated with a ventriculoperitoneal shunt with a programmable valve, presented to the emergency department because of a traumatic brain injury due to a fall from standing height. No previous complications were reported. He had an altered intracranial pressure (ICP) waveform in the emergency room when monitored with the brain4care device, with a P2/P1 ratio of 1.6. Imaging helped to confirm shunt dysfunction. Revision surgery normalized the ratio to 1.0, and the patient was discharged. Upon return after 14 days, an outpatient analysis revealed a ratio of 0.6, indicating improvement. LESSONS: In selected cases of NPH, noninvasive ICP waveform morphology analysis can be effective as a diagnostic aid, as well as in the pre- and postsurgical follow-up, given the possibility of comparing the values of ICP preoperatively and immediately postoperatively and the outpatient P2/P1 ratio, helping to manage these patients.
RESUMO
Intraorbital foreign body is a rare condition, especially when extending into the intracranial compartment. When facing this scenario in the ER, the neurosurgeon must carefully choose the optimal point of surgical access in order to reduce morbidity. The authors hereby report the case of a 66 year-old male with a penetrating trauma to the orbit reaching the anterior cranial base through the orbital roof and associated with an intracerebral hematoma. The removal of the foreign body was performed by a dual approach: an 'eyebrow' supraorbital keyhole craniotomy and an intra-orbital extra-ocular exploration, with later microsurgical drainage of the hematoma and evisceration of the eye 48 hours later. The patient developed a pseudomeningocele, which was treated with lumbar puncture and compressive dressing. After proper intravenous antibiotic prophylaxis, the patient was discharged 21 days after hospital admission.