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Submitted by: Abad, Maria Kathleen S. Alana, Krizzia Camille L. Alcoriza, Janine L. Almazan, Trisha M. Aliviz, Jeffrey M Ancheta, Janine Angelica Aricayos, Lea P. Basilio, Phylord B. Benito, Ann Jeka P. Canlas, Jillian Yvonne Raon, Maria Angelica (BSN 202)
SUBMITTED TO: Prof. Joepher Reuben Alcantara
Symptoms of acquired hydrocephalus can include: • • • • • • Headache Vomiting and nausea Blurry vision Balance problems Bladder control problems Thinking and memory problems Hydrocephalus can permanently damage the brain. If untreated. Medicine and rehabilitation therapy can also help. this fluid cushions your brain. AANATOMY AND PHYSIOLOGY . infections. it puts harmful pressure on your brain. When you have too much. Treatment usually involves surgery to insert a shunt. it is usually fatal. Normally. There are two kinds of hydrocephalus. many people lead normal lives with few limitations.DEFINITION OF THE DISEASE Hydrocephalus is the buildup of too much cerebrospinal fluid in the brain. tumors and bleeding in the brain. Causes include genetic problems and problems with how the fetus develops. though. causing problems with physical and mental development. Acquired hydrocephalus can occur at any age. Causes can include head injuries. An unusually large head is the main sign of congenital hydrocephalus. Congenital hydrocephalus is present at birth. strokes. With treatment.
Basal ganglia (basal nuclei) are several pockets of gray matter located deep inside the cerebral white matter. The corpus callosum is a major assemblage of association fibers that forms a nerve tract that connects the two cerebral hemispheres. or connect the cerebrum to the spinal cord (projection fibers). All but the insula are visible from the outside surface of the brain. The following four divisions are recognized DIVISIONS OF THE BRAIN The cerebrum consists of two cerebral hemispheres connected by a bundle of nerve fibers. called convolutions. The following terms are used to describe the convolutions A gyrus (plural. Arm swinging while walking. sulci) is a shallow groove among the convolutions. the occipital lobe. the parietal love. the corpus callosum. The cerebral white matter underlies the cerebral cortex. The deeper fissures divide the cerebrum into five lobes (most named after bordering skull bones)—the frontal lobe. It consists of the following major regions: The thalamus is a relay station for sensory nerve impulses traveling from the spinal cord to the cerebrum. A fissure is a deep groove among the convolutions. Some nerve impulses are sorted and grouped here before . and the globus pallidus—are involved in relaying and modifying nerve impulses passing from the cerebral cortex to the spinal cord. The largest and most visible part of the brain. conscious thinking. gyri) is an elevated ridge among the convolutions. Such activities as speech. appears as folded ridges and grooves. The major regions in the basal ganglia—the caudate nuclei. The diencephalon connects the cerebrum to the brain stem. is controlled here. and association areas. for example. It contains mostly myelinated axons that connect cerebral hemispheres (association fibers). the cerebrum. and the insula. the putamen. A sulcus (plural. These activities are grouped into motor areas. connect gyri within hemispheres (commissural fibers). A cross section of the cerebrum shows three distinct layers of nervous tissue: The cerebral cortex is a thin outer layer of gray matter. evaluation of stimuli. sensory areas.A second method for classifying brain regions is by their organization in the adult brain. and control of skeletal muscles occur here. the temporal lobe.
and temperature. are evaluated here also. The brain stem consists of the following four regions. . pressure. hunger. The mammillary bodies relay sensations of smell. The infundibulum connects the pituitary gland to the hypothalamus. The hypothalamus regulates numerous important body activities. thirst. The epithalamus contains the pineal gland. behavior. and the biological clock. a hormone that helps regulate the biological clock (sleep-wake cycles). body temperature. portions of the optic nerve from each eye cross over to the cerebral hemisphere on the opposite side of the brain. The pineal gland secretes melatonin. The brain stem connects the diencephalon to the spinal cord. Here.being transmitted to the cerebrum. The optic chiasma passes between the hypothalamus and the pituitary gland. such as pain. Certain sensations. The following structures are either included or associated with the hypothalamus. It controls the autonomic nervous system and regulates emotion. all of which provide connections between various parts of the brain and between the brain and the spinal cord. (Some prominent structures are illustrated in Figure 2). The brain stem resembles the spinal cord in that both consist of white matter fiber tracts surrounding a core of gray matter. It also produces two hormones (ADH and oxytocin) and various releasing hormones that control hormone production in the anterior pituitary gland.
anger. and memories. but the gyri. Other components of the reticular formation are responsible for maintaining muscle tone and regulating visceral motor muscles. are parallel and give a pleated appearance. the vermis. The reticular formation consists of small clusters of gray matter interspersed within the white matter of the brain stem and certain regions of the spinal cord. The reticular activation system (RAS). The limbic system is a network of neurons that extends over a wide range of areas of the brain. The cerebellum evaluates and coordinates motor movements by comparing actual skeletal movements to the movement that was intended. The pons is the bulging region in the middle of the brain stem. the surface of the cerebellum is convoluted. called folia. The following components are included: The hippocampus (located in the cerebral hemisphere) The denate gyrus (located in cerebral hemisphere) The amygdala (amygdaloid body) (an almond-shaped body associated with the caudate nucleus of the basal ganglia) The mammillary bodies (in the hypothalamus) The anterior thalamic nuclei (in the thalamus) The fornix (a bundle of fiber tracts that links components of the limbic system) . The limbic system imposes an emotional aspect to behaviors. the cerebellar hemispheres. and affection are imparted to events and experiences. Emotions such as pleasure. fear. Like that of the cerebrum. sorrow. The cerebellum consists of a central region. is responsible for maintaining wakefulness and alertness and for filtering out unimportant sensory information. diencephalon. experiences.Prominent structures of the brain stem The midbrain is the uppermost part of the brain stem. and cerebellum. one component of the reticular formation. The medulla oblongata (medulla) is the lower portion of the brain stem that merges with the spinal cord at the foramen magnum. The limbic system accomplishes this by a system of fiber tracts (white matter) and gray matter that pervades the diencephalon and encircles the inside border of the cerebrum. and two winglike lobes.
and 1 had cerebral atrophy (group 4). and thereafter at . Study Characteristics 1. Methodology/Design 1. Design. Sixty-eight (34 %) infants had intracranial hemorrhage. Clinical Question: Can intracranial hemmorhage progress to hydrocephalus? II. Population and Sample Two hundred and two consecutive admissions to a regional neonatal unit were scanned by real-time ultrasound. 3 had rapidly progressive hydrocephalus (group 3). Methodology Used. Interventions Compared and outcomes monitored interventions compared include: 1. Fifteen infants showed some degree of ventricular dilatation. Setting and Data Sources All infants admitted to the neonatal unit at Hammersmith Hospital during a period of 10 months from November 1979 were scanned sequentially with a Kranzbuhler ADR linear array real-time ultrasound machine. Duration of gestation was calculated according to maternal dates and gestational assessment. 39 (57 %) of whom were scanned repeatedly until they were at least 30 days old. Four had transient dilatation with complete recovery without any form of treatment (group 1). but abnormal rates of head growth were seen in groups 3 and 4. Starte III. 2.EVIDENCE BASED NURSING I. This study describes the incidence of ventricular dilatation after intracranial hemorrhage and the subsequent natural history of this condition in 202 consecutively-born neonates IV.3 Infants were scanned at least weekly and often daily while in the neonatal unit. Levene and David R. Occipitofrontal head circumference was also followed sequentially from birth and was not abnormal in groups 1 and 2. 7 showed persistent but non-progressive dilatation with no treatment (group 2). Citation: A longitudinal study of post-hemorrhagic ventricular dilatation in the newborn by Malcolm I.
this distance being referred to as the ventricular index.2 Measurement was made of the distance between the lateral ventricle and the falx. An infant was judged to have dilated ventricles if the ventricular index measurement showed an increase from a normal figure to one above the 97th centile for its gestational age on growth charts of the lateral ventricle. A flexible metal or glass fiber-coated linen tape was used. The results were plotted on composite occipitofrontal circumference charts which used the longitudinal growth data of Largo and Duc4 for infants of 32 weeks' gestational age and older. Only preterm infants or ones who were ill were admitted to our neonatal unit. and similar data prepared by one of us (DRS) from two west London hospital populations of infants under 32 weeks' maturity. Inclusion and Exclusion Criteria. and choroid plexus bleeds respectively. 2. A measurement of less than 6 mm from the floor of the lateral ventricle to its roof at this point was considered to be normal. V. In 13 (6%) infants the diagnosis of IVH could not be made with certainty because of technical difficulties. and each infant was measured by one person only (MIL or DRS) during his stay in the neonatal unit. a large subarachnoid hemorrhage was diagnosed on the clinical findings of neck stiffness in conjunction with . In our study. In all but 2 of these babies the origin of the bleeding was from the lateral ventricles. and Table 1 shows the distribution of intracranial hemorrhage according to gestational age for this highly selected population.all follow-up clinic attendances. The etiology of such conditions is different from that of subependymal hemorrhage and reflects a wider range of pathophysiological events leading to the hemorrhagic lesion. Results of the Study Intracranial hemorrhage was diagnosed on ultrasound examination in 68 (34%) infants. subdural. Ultrasound scans were performed (by MIL) in an axial plane through the temporoparietal region using a 5 MHz transducer and the methods for diagnosis of intracranial hemorrhage have been previously reported. 3 (8 %) of the 39 survivors of intracranial hemorrhage developed rapidly progressing hydrocephalus requiring shunting. In addition. but considerably more (31 %) babies than this showed some degree of ventricular dilatation. Subdural hemorrhage was diagnosed on ultrasound scanning in one patient (Case 14). Both these measurements could be made rapidly and with little difficulty. transfontanelle coronal scans of the body of the lateral ventricle were also performed with a 7 MHz transducer. and in another term infant. Maximal occipitofrontal head circumference was measured weekly on all 202 infants.5 or if the distance from the roof to the floor of the lateral ventricle exceeded 6 mm. Three term infants were included in this study in which the intracranial hemorrhage arose from subarachnoid.
These babies in our study received no treatment because the risks of shunting and lumbar puncture or other procedures were considered to outweigh the potential advantages of treatment. and group 4 (n = 1) showed ventricular dilatation but poor head growth because of cerebral atrophy. Follow-up data must be considered in evaluating the efficacy of treatment versus non-treatment of this condition. VII. to resolve adequately the question of whether and when to treat non-progressive ventricular dilatation. it is a very effective method or tool for decreasing the need for surgery.uniformly stained spinal fluid without IVH on ultrasound (Case 9). Four patterns of ventricular enlargement were noted: group 1 (n = 4) showed transient dilatation with complete resolution. a controlled clinical trial must be undertaken and neurological outcome be closely monitored. Safety . they are not functioning as well. VII. 8 of whom were 30 weeks or less. and all but 3 were 34 weeks or less. Applicability The study can be carried out in the real setting. In our opinion. VI. the study have been able to answer our clinical question which is about the progression of subarachnoid hemorrhage into hydrocephalus. Thirty-nine of the surviving infants with intracranial hemorrhage were seen at age 30 days or more. group 2 (n = 7) showed persistent but non-progressive dilatation. Fifteen (39 %). Bracing should never be disregarded as a solution though it may take time and lot of discomfort when using it. group 3 (n= 3) showed progressive dilatation of ventricles shortly after hemorrhage requiring shunting. EVALUATING NURSING CARE PROCESS 1. Still. Surgery can also cause portoperative problems that may complicate the problem. None of the infants with dilated ventricles received any treatment except for 3 with excessively rapid head growth and bulging fontanels in whom ventricular shunts were inserted. However. Have no foreseen bad effects on the client’s health status. the initial impression is that compared with matched infants with IVH but without ventricular dilatation. this may be due to the extent of the initial hemorrhage as much as to ventricular size. Although our follow-up results are incomplete. Author’s Conclusions The validity of undertaking treatment is most questionable in the sorts of infants similar to those in groups I and 2. of these 39 survivors developed dilated ventricles. Reviewer’s Conclusions Conservative methods of intervention for idiopathic scoliosis should be considered first before opting for surgery.
. this may be due to the extent of the initial hemorrhage as much as to ventricular size. they are not functioning as well.There is little agreement about the management of infants with dilated ventricles. bulging fontanels. 6. 2. sedation. The risk of transportation. to resolve adequately the question of whether and when to treat nonprogressive ventricular dilatation. Appropriateness The study is appropriate to the goal of researcher to identify or to prove that post.hemorrhagic can be as predisposing factor for having hydrocephalus in newborn. However. and arrest of the hydrocephalus incorrectly ascribed to treatment when ventricular dilatation might have been transient or subject to spontaneous arrest. medical management with glycerol18 or isosorbide7-has been undertaken. Competence of the nursing care provider Not Applicable. and splayed sutures may receive ventricular shunts. Those infants shown to have dilated ventricles on ultrasound before a rapid increase in head size has occurred may also be treated by these methods. Although our follow-up results are incomplete. In our opinion. a controlled clinical trial must be undertaken and neurological outcome be closely monitored. They introduced CT scanning that allows accurate diagnosis of IVH and early detection of hydrocephalus. And other treatments-such as regular cerebrospinal fluid taps13 19 or compressive head wrappings20 21-have been used in some centers. 5. Effectiveness The study is effective because it is proven that hemorrhage can lead to hydrocephalus. 4.hemorrhagic hydrocephalus. Acceptability The study is acceptable because it deals in a way that it will determine whether the hemorrhages can lead to hydrocephalus. the initial impression is that compared with matched infants with IVH but without ventricular dilatation. Those in whom there is rapid head growth. and radiation exposure inherent in CT scanning should make ultrasound the method of choice to diagnose and follow post. If the infant is frail. Efficiency Follow-up data must be considered in evaluating the efficacy of treatment versus nontreatment of this condition. 3.
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