presentation by victor Nguvulu

hydrocephalus
outline

• Anatomy and Normal flow of CSF

• Definition of hydrocephalus
• Epidemiology
• types of hydrocephalus
• Aetiology
• Pathophysiology
• Clinical presentation
• investigation
• Treatment and complications
 anatomy composition

Function: shock absorber,nutrients,link

Circulation and the Brain
• Hydrocephalus is a dilatation of the cerebral ventricular system, which is
due to either an obstruction to the flow of CSF, overproduction of CSF, or a
failure of reabsorption of CSF
• Epidemiology : incidence of congenital hydrocephalus is 3 per 1,000 live
births, while the incidence of acquired hydrocephalus is not known exactly.
types of hydrocephalus

: enlarged ventricles caused

by obstruction of CSF flow through the ventricular system (e.g.
stenosis of the aqueduct of sylvius)
: enlarged ventricles as a result of
increased production of CSF (e.g. tumors) or decreased
absorption of CSF (e.g. bacterial meningitis).
: this is enlargement of ventricular
system due to compensatory response to severe cortical atrophy.
It is not true hydrocephalus.
 etiology
congenital acquried
Arnold-Chiari malformation  Intraventricular hemorrhage (
type 1 and type 2. head injury)
Agenesis of the foramen of  Infection: tuberculosis ,
Monro. meningitis
Congenital toxoplasmosis.  Mass lesions usually tumors
Dandy-Walker malformation. (eg astrocytoma), but cysts,
Stenoses of the aqueduct of abscesses, or hematoma
Sylvius. also can be the cause
• Ventricular distension and increased ICP cause the
clinical manifestations of hydrocephalus
 CLINICAL FEATURES
History
Did the child have any fever before the head started getting big?
Any history of convulsions?
What was the baby’s head circumference at birth and was the baby born at term or
preterm
Any abnormality of the spine?
Any similar illness in the siblings?
Head circumference is in the 98th percentile for the age or greater.
Infants with open cranial sutures Older children with closed cranial
have the following clinical signs: sutures have signs of increased
ntracranial pressure:

Large anterior and posterior Headache

fontanelles and split sutures.
Sunset sign, a tonic downward
deviation of both eyes caused
by pressure from the enlarged
third ventricle ,Dilated scalp veins,Increased
limb tone due to stretching of the periventricular
pyramidal tract fibers
Nausea and vomiting
Unilateral sixth nerve palsy:
others :(in both open or closed
sutures)Shallow breathing ,Seizures, Loss of
consciousness, Coma
Investigations
• Ultrasound (in infants), CT, or MR for diagnosis of communicating
hydrocephalus
• MR for diagnosis of noncommunicating hydrocephalus
• Ultrasound (in infants) or CT to follow ventricular size in response to
treatment
• A CT scan or MRI of the head is recommended for children with a
meningocele because of the association with hydrocephalus in some
cases
• plan x ray of skull

• Differential diagnosis
• Megaencephally: no raised ICP, no dilated ventricals
• Chronic subdural heamatoma: large head mostly in parietal regions, no
prominent scalp veins, no sunset sign
– Decreasing CSF secretion by the choroid plexus - Acetazolamide and
furosemide
– Increasing CSF reabsorption - Isosorbide (effectiveness is questionable)
• Requires the surgical placement of a ventriculoperitoneal shunt to divert the flow of
CSF.
o Ventricular-lumbar shunt
o Ventricular-atrial shunt
o Ventricular-pleural shunt
o Ventricular-spinal shunt
o Ventricular-osseus shunt
Complications of management
early: over drainage, underdrainage
intermediate: infection, peritonitis,septicemia, shunt embolus,
endocarditis, and pulmonary hypertension.
Late: shunt becoming short as the child is growing, blocked
shunt,
the end