Subdural hematoma as a complication of shunting procedures for normal pressure hydrocephalus

✓ The authors report five patients with normal-pressure hydrocephalus (NPH) who developed subdural hematomas following shunt procedures. None of the hematomas was directly related to surgery, and all appeared after the patients had shown initial clinical improvement; one was conceivably related to trauma. These patients appear to be especially susceptible to this complication, as the high incidence of 5 of 24 cases is not seen in the treatment of high-pressure hydrocephalus. The symptoms and signs of this complication, diagnosis, and treatment are described and emphasized. It is concluded that shunting procedures for NPH should not be undertaken lightly, and rigid criteria should be applied in the selection of patients to exclude other causes of dementia.