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Dr. Ummu Atiah, Sp.

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This results from either  (a) Increased production (rare)  (b) Impaired absorption (common) . Definition  Hydrocephalus is an increase in the cerebrospinal fluid.

It travels inferiorly form the lateral to the 3rd ventricle through the aqueduct of Sylvie’s. Formation  CSF is made by the choroids plexus of the lateral and 4th ventricles. . From here. to the 4th ventricle and finally exits the ventricular system through the foramina of Luschka and Magendie into the subarachnoid space. it flows superiorly until it gets absorbed by subarachnoid granulations into the sinuses of the venous system.

. This occurs commonly with posterior fossa tumors. One can see that a tumor of the cerebellum could impinge upon the 4th ventricle and cause an obstructive hydrocephalus.Figure 1 Here is the direction of flow of the CSF from the foramina of luschka & Magendie to the subarachnoid granulations.

If they are obstructed a communicating hydrocephalus occurs.We can see the subarachnoid granulations. .

.Figure 1.5 Here we see quite clearly how easily a cerebellar tumor could impinge upon the 4th ventricle and cause an obstructive hydrocephalus.

Pathological effects •CSF penetrates through the ependymal lining into per- ventricular white matter causing (A) Raised ICP (B) White matter damage and glial scarring .

. Figure 3 Here we see a gross coronal section of a brain with hydrocephalus illustrating the gross dilatition of the lateral ventricles at the level of the temporal lobes. At this point the lateral ventricles should not be visible.

Classification  Obstructive:obstruction within the ventricular system  Communicating: the obstruction is in the subarachnoid space or venous sinuses or there is increased CSF production as in a choroids plexus papilloma. .

impaired conscious level. and impaired ability for upward gaze.mental retardation and failure to thrive  In general there is :  increased skull circumference and radiographic evidence of mal- fusion of cranial sutures. . and vomiting  Gradual onset. Clinical features  Infants & young children:  Acute onset-irritability.  lid retraction.

Investigations  : suggests a communicating hydrocephalus. There can be evidence of chronic raised ICP resulting in erosion of the posterior clinoid processes.  x-ray: skull size increased and suture width increased.  CT scan:  The pattern of ventricular enlargement can help delineate the cause:  Lateral & 3rd ventricle dilatation  → normal 4th ventricle: suggests aqueduct stenosis  → deviated or absent 4th ventricle: suggests posterior fossa tumor  Generalized dilatation .

. pointing to malfusion of the coronal suture to hydrocephalus and the resulting raised intracranial . Here we see a cranial X-ray with radiolucency.

CT Scan .

which is in contact with another catheter that lies in the foramen of Munroe.peritoneal shunt: a catheter is inserted into the peritoneum and tunneled subcutaneously into the reservoir. or lumbar puncture( if intracranial mass lesion is not suspected)  Gradual onset: ventriculo-peritoneal shunt and of course removal of lesion if possible  Ventriculo. Management  Acute onset: ventricular drainage. . ventriculo-peritoneal shunt.

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as well as impaired upward gaze. vomiting. and incontinence. . papilledema and deteriorating conscious level. gait ataxia.headache.  Gradual onset: this can result in dementia. Juvenile & adult:  Acute onset : signs symptoms of increased ICP.

Pathological effects  CSF penetrates through the ependymal lining into per-ventricular white matter causing  (A) Raised ICP  (B) White matter damage and glial scarring .

the earlier hydrocephalus is diagnosed. and the timeliness of diagnosis and treatment. .  Ingeneral. Prognosis  Theprognosis for hydrocephalus depends on :  thecause. the better the chance for successful treatment. the extent of symptoms.