HYDROCEPHALUS  Overproduction of fluid by a choroid

plexus in first or second ventricle, as could

occur from a growing tumor (rare).
 Obstruction occurs because infections
such as meningitis or encephalitis may
leave adhesions behind that block fluid
flow.
 Obstruction of the passage:
 in narrow aqueduct of Sylvius (the
most common cause)
 foramina of Magendie
CSF  formed in the first and second ventricles  Luschka, the openings that allow fluid
of the brain  passes through the aqueduct of to leave the fourth ventricle
Sylvius and the fourth ventricle  empty into the  Hemorrhage from trauma or a
subarachnoid space of the spinal cord growing tumor
absorbed  An Arnold-Chiari disorder
 elongation of the lower
 is an excess of CSF in the ventricles or the
brain stem and
subarachnoid space
displacement of the fourth
 excess fluid causes enlargement of the
ventricle into the upper
skull in the infant whose cranial sutures
cervical canal
are not firmly knitted
 An interference with the absorption of CSF
 classified regarding whether it occurs at
from the subarachnoid space
birth (congenital) or from an incident later
in life (acquired) surgery for meningocele  portion of the
 3 to 4 per 1000 live births subarachnoid membrane is removed

fluid reaches the spinal cord  the disorder is extensive subarachnoid hemorrhage  portions
called communicating hydrocephalus or of the membrane absorption surface become
extraventricular hydrocephalus obscured

a block to such passage of fluid  the disorder is

an obstructive hydrocephalus or
ASSESSMENT
intraventricular hydrocephalus
 prenatal sonogram
 can be shunted in utero
CAUSE  infant’s fontanelles widen and appear
tense
 unknown
 the suture lines on the skull separate
FACTORS  the head diameter enlarges

 maternal infection  scalp becomes shiny

o toxoplasmosis  scalp veins become prominent

 brow bulges forward (bossing)
o infant meningitis
 eyes become “sunset eyes” (the sclera
shows above the iris because of upper lid

excess of CSF in the newborn occurs because: retraction)

 symptoms of increased intracranial
pressure
 decreased pulse and respirations
  increased temperature and blood Chun gun] against the skull with the child
pressure in a darkened room)
 hyperactive reflexes  reveal the skull is filled with fluid
 strabismus rather than solid brain
 optic atrophy  If a noncommunicating type,
 irritable  Dye inserted into a ventricle
 lethargic through the anterior fontanelle will
 fail to thrive not appear in CSF obtained from a
 typical shrill lumbar puncture.
 high-pitched cry
 Measure the head circumference of all
infants within an hour of birth and again THERAPEUTIC MANAGEMENT

before discharge from the health care

If caused by overproduction of fluid,
facility to establish a baseline.
acetazolamide (Diamox), a diuretic, may be
 Older children who have suffered head
prescribed to promote the excretion of this
trauma should have their head
excess fluid.
circumference noted at the time of the
accident.  ventricular endoscopy

 Note any asymmetry that is occurring,  Destruction of a portion of the

because this may suggest the point of choroid plexus may be attempted

obstruction by

 skull that is enlarging anteriorly with a  removal of the tumor

shallow posterior fossa, for example,  if a tumor in that area is

suggests the obstruction is in the responsible for the overproduction

aqueduct or third ventricle. of fluid

 infant’s motor function becomes impaired  laser surgery

as the head enlarges, because of both  to reopen the route of flow or

neurologic impairment and atrophy caused bypassing the point of obstruction

by the inability to move such a heavy by shunting the fluid to another

head. point of absorption

 a child with more than 1 cm of cerebral  shunting procedure

tissue present has no impaired motor  involves threading a thin

function polyethylene catheter under the

 Even with an extremely enlarged head, skin from the ventricles to the

children’s intelligence may remain normal, peritoneum

although fine motor development may be  Fluid drains via this route into the

affected peritoneum and is absorbed across

 demonstrated by: the peritoneal membrane into the

 ultrasound body circulation.

 computed tomography (CT)  Usually has to be replaced as the

 magnetic resonance imaging (MRI) child grows or it will become too

 A skull x-ray film short

 reveal the separating sutures and  could become enclosed in a fold of

thinning of the skull peritoneum and become obstructed

 Transillumination (holding a bright light  could become infected

such as a flashlight/ specialized light [a  The ultimate prognosis depends on

whether brain damage occurred before
shunting and, if a shunt is in place,
 whether the parents can recognize when it  Be certain a child receives adequate pain
needs to be replaced to prevent increased management, because crying elevates
intracranial pressure. CSF pressure.

2. Risk for imbalanced nutrition, less than

body requirements, related to increased
intracranial pressure
NURSING DIAGNOSIS  most children NGT placed during surgery
 NPO  bowel sounds return  tube
1. Risk for ineffective cerebral tissue
can be removed  introduce fluid
perfusion related to increased intracranial
gradually in small quantities  to avoid
pressure
 After a shunt is inserted, the infant’s bed vomiting leading to increased intracranial

is usually left flat or raised only about 30 pressure

degrees so the child’s head remains level  held when being fed if possible

with the body.  Note how the child sucks

 if the child’s head is raised excessively  Observe for constipation

CSF may flow too rapidly 

decompression  possible tearing of
3. Risk for impaired skin integrity related to
cerebral arteries
extra weight and immobility of head
 one-way valve is inserted in the shunt
 Wash the child’s head daily
that opens when CSF has accumulated to
 change the position of the head
the extent that pressure has increased
approximately every 2 hours
 Assess for signs of increased intracranial
 A synthetic sheepskin or silicon pad or an
pressure after surgery such as:
air, water, or alternating air mattress may
 tense fontanelles
help to relieve pressure points
 increasing head circumference
 irritability or lethargy
 decreased level of consciousness
4. Deficient knowledge related to home care
 poor sucking ability
needs of child with hydrocephalus
 vomiting
5. Risk for delayed growth and development
 an increase in blood pressure
related to potential neurologic challenge
(difficult to measure accurately in
infants unless arterial or umbilical
lines are used with Doppler
Baby Sparrow may be developing increased
instrumentation)
intracranial pressure.
 increasing temperature
 decrease in pulse and respiratory What vital sign changes occur with this?

rates a. Decreased temperature; increased blood

 assess for symptoms of infection such as: pressure.
 increased temperature
b. Increased respirations; decreased pulse rate.
 increased pulse rate
 general malaise c. Increased temperature; decreased pulse rate.
 signs of meningitis such as:
d. Decreased blood pressure; increased
 a stiff neck
temperature.
 marked irritability