Delayed Decision-Making Results in Poor Outcomes: A Case Report of Visual Disturbance in a Patient with Hydrocephalus

Blindness is a rare complication of obstructive hydrocephalus (OH).Optic nerve sheath edema (ONSE), typically accompanied by papilledema and visual dysfunction, is associated with OH.Cerebrospinal fluid (CSF) diversion may help control intracranial hypertension, papilledema, and ONSE.However, when CSF diversion is delayed, visual disturbances may persist.A 38-year-old man presented to the neurosurgery outpatient clinic with limb weakness that had caused gait difficulty for approximately 2 weeks.He subsequently developed diplopia and dizziness.Initial physical examination and brain computed tomography did not identify a clear cause of these symptoms.However, intracranial hypertension, diagnosed after intracranial pressure measurement following external ventricular drain insertion, was considered to be associated with the patient's visual disturbance, headache, and dizziness.An additional ventriculoperitoneal shunt was inserted.Although the patient's visual disturbance improved slightly after treatment, permanent visual impairment was considered likely because retinal damage had already progressed, possibly in relation to delayed treatment decision-making.Delayed recognition and treatment of increased intracranial pressure may result in irreversible visual impairment in patients with OH.This case highlights the importance of prompt diagnostic evaluation, timely CSF diversion, and active communication with patients and caregivers to preserve visual function and improve clinical outcomes.