{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T23:27:58Z","timestamp":1769729278117,"version":"3.49.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"27","license":[{"start":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T00:00:00Z","timestamp":1735516800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,12,30]]},"abstract":"\n BACKGROUND<\/jats:title>\n Aneurysmal subarachnoid hemorrhage (aSAH) is often associated with acute high-pressure hydrocephalus. Less commonly, an acute low-pressure hydrocephalus (ALPH) variant can develop and contribute to increased morbidity. ALPH is particularly challenging to diagnose and manage, as patients present with symptoms of increased intracranial pressure (ICP) despite the absence of corroborating evidence from ICP measurements. Misdiagnosis or delayed recognition can result in increased morbidity.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors describe a patient with aSAH who developed neurological deterioration from ALPH. Despite normal ICP readings, the patient displayed symptoms of increased ICP. Significant electroencephalography (EEG) changes preceded the neurological deterioration by many hours. In addition, these EEG changes reversed with cerebrospinal fluid removal and eventual hydrocephalus resolution.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n ALPH presents with paradoxical ICP dynamics, complicating its diagnosis. Careful monitoring, including EEG, can provide an early indication of neurological deterioration and guide timely intervention. This case underscores the importance of considering ALPH in patients with aSAH who show clinical worsening without corresponding increases in ICP. Tailoring management to address the atypical pressure dynamics is crucial for improving outcomes.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24612<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24612","type":"journal-article","created":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T01:47:15Z","timestamp":1735523235000},"source":"Crossref","is-referenced-by-count":0,"title":["Continuous quantitative electroencephalography for early detection of acute low-pressure obstructive hydrocephalus in aneurysmal subarachnoid hemorrhage: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Jing","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Medicine, Neuroscience Intensive Care Unit, Medical Critical Care Service, INOVA Fairfax Hospital, Falls Church, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramani","family":"Balu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Neuroscience Intensive Care Unit, Medical Critical Care Service, INOVA Fairfax Hospital, Falls Church, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ameet","family":"Chitale","sequence":"additional","affiliation":[{"name":"Neuroscience and Spine Institute, INOVA Fairfax Hospital, Falls Church, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allen","family":"Waziri","sequence":"additional","affiliation":[{"name":"iCE Neurosystems, Inc., Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laith R.","family":"Altaweel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Neuroscience Intensive Care Unit, Medical Critical Care Service, INOVA Fairfax Hospital, Falls Church, Virginia"},{"name":"Neuroscience and Spine Institute, INOVA Fairfax Hospital, Falls Church, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"7","key":"bib1","series-title":"Stroke","first-page":"e314","article-title":"2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association\/American Stroke Association","volume":"54","author":"Hoh","year":"2023","unstructured":"Hoh BLKo NUAmin-Hanjani S, et al. 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association\/American Stroke Association. Stroke. 2023;54(7):e314-e370."},{"issue":"4","key":"bib2","series-title":"Neurosurgery","first-page":"643","article-title":"Low-pressure hydrocephalic state and viscoelastic alterations in the brain","volume":"35","author":"Pang","year":"1994","unstructured":"Pang DAltschuler E. Low-pressure hydrocephalic state and viscoelastic alterations in the brain. Neurosurgery. 1994;35(4):643-656."},{"issue":"1","key":"bib3","series-title":"J Neurosurg","first-page":"300","article-title":"Acute low-pressure hydrocephalus: a case series and systematic review of 195 patients","volume":"135","author":"Keough","year":"2021","unstructured":"Keough MBIsaacs AMUrbaneja GDronyk JLapointe APHamilton MG. Acute low-pressure hydrocephalus: a case series and systematic review of 195 patients. J Neurosurg. 2021;135(1):300-308."},{"key":"bib4","series-title":"Acta Neurochir Suppl","first-page":"155","article-title":"Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH)","volume":"113","author":"Hamilton","year":"2012","unstructured":"Hamilton MGPrice AV. Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH). Acta Neurochir Suppl. 2012;113:155-159."},{"key":"bib5","series-title":"Electroencephalogr Clin Neurophysiol","first-page":"123","article-title":"Electroencephalographic abnormalities in non-tumor hydrocephalus","volume":"14","author":"Bogacz","year":"1962","unstructured":"Bogacz JRebollo MA. Electroencephalographic abnormalities in non-tumor hydrocephalus. Electroencephalogr Clin Neurophysiol. 1962;14:123-125."},{"issue":"2","key":"bib6","series-title":"Electroencephalogr Clin Neurophysiol","first-page":"203","article-title":"The electroencephalogram in cases of tumors of the posterior fossa and third ventricle","volume":"5","author":"Daly","year":"1953","unstructured":"Daly DWhelan JLBickford RGMaccarty CS. The electroencephalogram in cases of tumors of the posterior fossa and third ventricle. Electroencephalogr Clin Neurophysiol. 1953;5(2):203-216."},{"key":"bib7","series-title":"Handbook of Clinical Neurology","first-page":"39","article-title":"Cerebrospinal fluid circulation and hydrocephalus","volume":"145","author":"Leinonen","year":"2017","unstructured":"Leinonen VVanninen RRauramaa T. Cerebrospinal fluid circulation and hydrocephalus. In: de Belleroche J, ed. Handbook of Clinical Neurology. Vol 145. Elsevier; 2017:39-50."},{"issue":"4","key":"bib8","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage","volume":"54","author":"Czorlich","year":"2023","unstructured":"Czorlich PSchweingruber NG\u00f6ttsche JMader MMWestphal M. Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage. Neurosurg Focus. 2023;54(4):E5."},{"issue":"1","key":"bib9","series-title":"Sci Rep","first-page":"6148","article-title":"Indication of thalamo-cortical circuit dysfunction in idiopathic normal pressure hydrocephalus: a tensor imaging study","volume":"10","author":"Eleftheriou","year":"2020","unstructured":"Eleftheriou ABlystad ITisell AGasslander JLundin F. Indication of thalamo-cortical circuit dysfunction in idiopathic normal pressure hydrocephalus: a tensor imaging study. Sci Rep. 2020;10(1):6148."},{"issue":"Pt","key":"bib10","series-title":"Brain","first-page":"2904","article-title":"Idiopathic normal pressure hydrocephalus: increased supplementary motor activity accounts for improvement after CSF drainage","volume":"131","author":"Lenfeldt","year":"2008","unstructured":"Lenfeldt NLarsson ANyberg L, et al. Idiopathic normal pressure hydrocephalus: increased supplementary motor activity accounts for improvement after CSF drainage. Brain. 2008;131(Pt11):2904-2912."},{"issue":"2","key":"bib11","series-title":"J Clin Neurophysiol","first-page":"149","article-title":"Nonepileptic electroencephalographic correlates of episodic increases in intracranial pressure","volume":"39","author":"Sheikh","year":"2022","unstructured":"Sheikh ZBMaciel CBDhakar MBHirsch LJGilmore EJ. Nonepileptic electroencephalographic correlates of episodic increases in intracranial pressure. J Clin Neurophysiol. 2022;39(2):149-158."},{"issue":"6","key":"bib12","series-title":"J Clin Neurophysiol","first-page":"562","article-title":"EEG correlates of spikes in intracranial pressure caused by transient ventriculoperitoneal shunt malfunction","volume":"40","author":"Wang","year":"2023","unstructured":"Wang PDona AKhetarpal NReeder SRobertson JPatel S. EEG correlates of spikes in intracranial pressure caused by transient ventriculoperitoneal shunt malfunction. J Clin Neurophysiol. 2023;40(6):562-565."},{"issue":"6","key":"bib13","series-title":"J Clin Neurophysiol","first-page":"594","article-title":"Idiopathic normal pressure hydrocephalus, quantitative EEG findings, and the cerebrospinal fluid tap test: a pilot study","volume":"31","author":"Seo","year":"2014","unstructured":"Seo JGKang KJung JYPark SPLee MGLee HW. Idiopathic normal pressure hydrocephalus, quantitative EEG findings, and the cerebrospinal fluid tap test: a pilot study. J Clin Neurophysiol. 2014;31(6):594-599."},{"issue":"7","key":"bib1","series-title":"Stroke","first-page":"e314","article-title":"2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association\/American Stroke Association","volume":"54","author":"Hoh","year":"2023","unstructured":"Hoh BLKo NUAmin-Hanjani S, et al. 2023 guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association\/American Stroke Association. Stroke. 2023;54(7):e314-e370."},{"issue":"4","key":"bib2","series-title":"Neurosurgery","first-page":"643","article-title":"Low-pressure hydrocephalic state and viscoelastic alterations in the brain","volume":"35","author":"Pang","year":"1994","unstructured":"Pang DAltschuler E. Low-pressure hydrocephalic state and viscoelastic alterations in the brain. Neurosurgery. 1994;35(4):643-656."},{"issue":"1","key":"bib3","series-title":"J Neurosurg","first-page":"300","article-title":"Acute low-pressure hydrocephalus: a case series and systematic review of 195 patients","volume":"135","author":"Keough","year":"2021","unstructured":"Keough MBIsaacs AMUrbaneja GDronyk JLapointe APHamilton MG. Acute low-pressure hydrocephalus: a case series and systematic review of 195 patients. J Neurosurg. 2021;135(1):300-308."},{"key":"bib4","series-title":"Acta Neurochir Suppl","first-page":"155","article-title":"Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH)","volume":"113","author":"Hamilton","year":"2012","unstructured":"Hamilton MGPrice AV. Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH). Acta Neurochir Suppl. 2012;113:155-159."},{"key":"bib5","series-title":"Electroencephalogr Clin Neurophysiol","first-page":"123","article-title":"Electroencephalographic abnormalities in non-tumor hydrocephalus","volume":"14","author":"Bogacz","year":"1962","unstructured":"Bogacz JRebollo MA. Electroencephalographic abnormalities in non-tumor hydrocephalus. Electroencephalogr Clin Neurophysiol. 1962;14:123-125."},{"issue":"2","key":"bib6","series-title":"Electroencephalogr Clin Neurophysiol","first-page":"203","article-title":"The electroencephalogram in cases of tumors of the posterior fossa and third ventricle","volume":"5","author":"Daly","year":"1953","unstructured":"Daly DWhelan JLBickford RGMaccarty CS. The electroencephalogram in cases of tumors of the posterior fossa and third ventricle. Electroencephalogr Clin Neurophysiol. 1953;5(2):203-216."},{"key":"bib7","series-title":"Handbook of Clinical Neurology","first-page":"39","article-title":"Cerebrospinal fluid circulation and hydrocephalus","volume":"145","author":"Leinonen","year":"2017","unstructured":"Leinonen VVanninen RRauramaa T. Cerebrospinal fluid circulation and hydrocephalus. In: de Belleroche J, ed. Handbook of Clinical Neurology. Vol 145. Elsevier; 2017:39-50."},{"issue":"4","key":"bib8","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage","volume":"54","author":"Czorlich","year":"2023","unstructured":"Czorlich PSchweingruber NG\u00f6ttsche JMader MMWestphal M. Acute low-pressure hydrocephalus in aneurysmal subarachnoid hemorrhage. Neurosurg Focus. 2023;54(4):E5."},{"issue":"1","key":"bib9","series-title":"Sci Rep","first-page":"6148","article-title":"Indication of thalamo-cortical circuit dysfunction in idiopathic normal pressure hydrocephalus: a tensor imaging study","volume":"10","author":"Eleftheriou","year":"2020","unstructured":"Eleftheriou ABlystad ITisell AGasslander JLundin F. Indication of thalamo-cortical circuit dysfunction in idiopathic normal pressure hydrocephalus: a tensor imaging study. Sci Rep. 2020;10(1):6148."},{"issue":"Pt","key":"bib10","series-title":"Brain","first-page":"2904","article-title":"Idiopathic normal pressure hydrocephalus: increased supplementary motor activity accounts for improvement after CSF drainage","volume":"131","author":"Lenfeldt","year":"2008","unstructured":"Lenfeldt NLarsson ANyberg L, et al. Idiopathic normal pressure hydrocephalus: increased supplementary motor activity accounts for improvement after CSF drainage. Brain. 2008;131(Pt11):2904-2912."},{"issue":"2","key":"bib11","series-title":"J Clin Neurophysiol","first-page":"149","article-title":"Nonepileptic electroencephalographic correlates of episodic increases in intracranial pressure","volume":"39","author":"Sheikh","year":"2022","unstructured":"Sheikh ZBMaciel CBDhakar MBHirsch LJGilmore EJ. Nonepileptic electroencephalographic correlates of episodic increases in intracranial pressure. J Clin Neurophysiol. 2022;39(2):149-158."},{"issue":"6","key":"bib12","series-title":"J Clin Neurophysiol","first-page":"562","article-title":"EEG correlates of spikes in intracranial pressure caused by transient ventriculoperitoneal shunt malfunction","volume":"40","author":"Wang","year":"2023","unstructured":"Wang PDona AKhetarpal NReeder SRobertson JPatel S. EEG correlates of spikes in intracranial pressure caused by transient ventriculoperitoneal shunt malfunction. J Clin Neurophysiol. 2023;40(6):562-565."},{"issue":"6","key":"bib13","series-title":"J Clin Neurophysiol","first-page":"594","article-title":"Idiopathic normal pressure hydrocephalus, quantitative EEG findings, and the cerebrospinal fluid tap test: a pilot study","volume":"31","author":"Seo","year":"2014","unstructured":"Seo JGKang KJung JYPark SPLee MGLee HW. Idiopathic normal pressure hydrocephalus, quantitative EEG findings, and the cerebrospinal fluid tap test: a pilot study. J Clin Neurophysiol. 2014;31(6):594-599."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/8\/27\/article-CASE24612.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/8\/27\/article-CASE24612.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/8\/27\/article-CASE24612.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:53:55Z","timestamp":1769687635000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/8\/27\/article-CASE24612.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,30]]},"references-count":26,"journal-issue":{"issue":"27"},"URL":"https:\/\/doi.org\/10.3171\/case24612","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,30]]}}}