Hydrocephalus, ventriculomegaly and the vegetative state: A review

Abstract

The revised guidelines from the Royal College of Physicians make it clear that structural problems such as hydrocephalus should be excluded before the diagnosis of vegetative state (VS) can be made. Ventriculomegaly is common after severe head injury but the distinction between atrophy and potentially treatable hydrocephalus cannot be made on the basis of conventional computerised tomographic (CT) or magnetic resonance (MR) scanning alone—physiological measurements of intracranial pressure (ICP) and cerebrospinal fluid (CSF) outflow resistance may be helpful. These techniques are reviewed together with the limited literature available that documents the effect of CSF diversion on outcome in “vegetative” patients.

Acknowledgments

The authors are very grateful to Professor David Graham for his permission to reproduce Figure 1. This work was supported by the Smith's Charity, UK and an MRC Programme Grant (number G9439390 ID56833).