Spontaneous subarachnoid hemorrhage complicated by communicating hydrocephalus: epsilon amino caproic acid as a possible predisposing factor.

An increased incidence of communicating hydrocephalus following subarachnoid hemorrhage has been observed on the neurosurgical service at Vanderbilt University Hospital during the past four years. This increase parallels the time interval during which epsilon amino caproic acid (Amicar) has been used in the preoperative regimen for intracranial aneurysms to prevent recurrent hemorrhage. Radiographic studies of 48 patients with subarachnoid hemorrhage not receiving Amicar were compared with 46 similar patients treated with this antifibrinolytic agent. In the series not treated with Amicar, a 17% incidence of dilated lateral ventricles was found, with 10% of the series being symptomatic from their hydrocephalus. A total of 43% of patients in the group treated with Amicar demonstrated dilated ventricles, with 31% of the group clinically symptomatic. Mechanisms of action of Amicar possibly implicated in this increased incidence of hydrocephalus are discussed.