Hydrocephalus

Hydrocephalus

obstruction to the flow of CSF
1. -> dilatation of ventricular sys prox to obstruction site
2. within ventricular sys or aqueduct
  1. non communicating or obstructive hydrocephalus
    1. causes
      1. congenital malformation
        aqueduct stenosis
        atresia of outflow foramina of 4th ventricle (Dandy-Walker formation)
        Chiari malformation
    2. post fossa neoplasm or vascular malformation
    3. intraventricular haemorrhage in preterm infant
3. at arachnoid villi (site of absorption of CSF)
  1. communicating hydrocephalus (failure to reabsorb CSF)
    1. causes
      1. subarachnoid haemorrhage
      2. meningitis e.g. pneumococcal, tuberculous
untreated
1. grossly enlarged head
2. downward deviation of the eyes (setting sun sign)
Rx
1. ventriculoperitoneal shunt
  1. for drainage of symptomatic hydrocephalus
  2. extra length of shunt tubing is left in peritoneal cav to allow for child's growth
  3. mainstay
  4. shunts can malfunction
    1. due to blockage or infection (usually coag -ve staph)
    2. then need replacing or revision
2. ventriculoatrial shunt
  1. right atrial catheters need revision w/ growth
  2. w/ regulatory valves
    1. to avoid overdrainage of fluid
      1. can cause low Pa headaches
3. for symptomatic relief of raised ICP & reduce risk of neuro damage
4. ventriculostomy via endoscopic Rx
clinical features
1. disprop large head circumference or excessive growth rate
  1. in infants w/ condition as skull sutures haven't fused
    1. the skull sutures separate, the ant fontanelle bulges & scalp vv become distended
2. fixed downward gaze or sun setting of eyes
  1. an advanced sign
3. older children
  1. sx & signs of raised ICP
diag
1. antenatal ultrasound screening
2. routine cranial ultrasound screening in pretermies
3. for suspected hydrocephalus
  1. initial assessment
    1. cranial ultrasound in infants
    2. CT or MRI

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	Created by v.djabatey over 10 years ago