Introduction: Hydrocephalus is a devastating complication in the clinical course of subarachnoid hemorrhage (SAH), with incidence up to 67%. Its onset can be acute - within 48 hours, and rarely (in 10-20%) chronic - occurring weeks until months after SAH.. Study suggests that fibrosis of leptomeninges and arachnoid granulations results from blood product deposition may cause impaired cerebrospinal fluid flow and absorption. Other theory suggests that vasospasm of the choroid artery in SAH could probably lead to hydrocephalus.

Findings: We hereby report a 73-year-old female presented with progressive deterioration of consciousness and broca aphasia a week before admission. She was hypertensive and diabetic, with no history of heart disease. There was a history of hospitalization due to SAH 3 months ago without any sequela afterwards. She also experienced an ischemic stroke 2 weeks after, and had a right-sided weakness since then. Upon admission, she was stuporous, and physical examination revealed nuchal rigidity, right-sided weakness, and spasticity of her right extremities. Brain CT Scan shows a communicating hydrocephalus, old infraction in the left pons, thalamus, internal capsule, and an isodense lesion in the left internal carotid-posterior communicating artery, suggesting an aneurysm. Acetazolamide was administered along with antibiotic and steroids. The following day, the patient regained consciousness, but remained aphasic and weak on her right side. 

Conclusion: Late onset hydrocephalus is an uncommon complication of SAH which may cause deterioration of functional outcomes. Early recognition and appropriate treatment can prevent sequela hence lead to a better prognosis.

LATE ONSET HYDROCEPHALUS AFTER SUBARACHNOID HEMORRHAGE: A CASE REPORT