Most patients with moderate ventriculomegaly do not develop significant symptoms, and ventriuclar size gradually returns to normal. With an unsecured aneurysm, one should avoid overdrainage of a ventriculostomy by gradually lowering the ICP to 15-20 mm Hg. There is an apparent association between ventriculomegaly and the development of vasospasm. For patients with acute hydrocephalus and diminshed level of consciousness after SAH, placement of a ventriculostomy is recommended. However, this subgroup of patients has a higher mortality rate than untreated patients with hydrocephalus or patients with SAH overall.
Thes is an increased rate of rebleeding with placement of ventriculostomy.
Fluid restriction for the treatment of hyponatremia is associated with increased incidence of delayed ischemic deficits, and volume contraction is linked to symptomatic vasospasm. There is a possible relationship of hyponatremia to excessive natriuresis and volume contraction. Therefore, management of hyponatremia after SAH should avoid volume contraction. Management should include intravascular administration of isotonic fluids. Fluid restriction should not be instituted to treat hyponatremia.