Acute decompensation of chronic hydrocephalus following elective abdominal surgery presenting as paroxysmal sympathetic hyperactivity: illustrative case

Patients with chronic untreated hydrocephalus can decompensate due to increased physiological stress. Adult patients with untreated chronic hydrocephalus should be counseled about this possibility and evaluated carefully by a multidisciplinary team before consenting to major elective surgery. The presentation of acute decompensation can include paroxysmal sympathetic hyperactivity, which should be diagnosed and treated urgently, even if there is no radiological evidence of ventricular change. https://thejns.org/doi/10.3171/CASE2547.