DefinePK

Abstract

Background: Headache is one of the most common reasons for emergency department (ED) visits. Hydrocephalus, although rare, can present with non-specific symptoms like headache, nausea, and altered mental status, often leading to delayed diagnosis. Objective: To determine the frequency of undiagnosed hydrocephalus among adults presenting with headaches to the ED and to identify associated clinical features. Methodology: A cross-sectional analytical study was conducted at Nishtar Medical University, Multan, Pakistan, from January 2023 to December 2023. A total of 381 adult patients presenting with headache as the primary complaint and undergoing neuroimaging (CT or MRI) were included. Patients with known neurological conditions, traumatic head injury, or subarachnoid hemorrhage were excluded. Data on demographic and clinical features were collected using a structured tool. Hydrocephalus was diagnosed radiologically and classified as obstructive or non-obstructive. Univariate and multivariate analyses were performed to identify predictors of undiagnosed hydrocephalus. Results: Out of 381 patients, 5 (1.3%) were diagnosed with hydrocephalus, previously undiagnosed. Among these, 3 (60%) had obstructive hydrocephalus and 2 (40%) had a non-obstructive type. All cases were detected incidentally through neuroimaging. On univariate analysis, altered mental status and gait disturbance were significantly associated with hydrocephalus. Multivariate analysis confirmed that altered mental status was an independent predictor (OR = 4.6; 95% CI: 1.5–13.9; p = 0.007). Conclusion: Undiagnosed hydrocephalus was identified in many adult ED patients presenting with headache. Altered mental status emerged as a significant clinical predictor.