Hydrocephalus

• hydro - means water
• cephalus- refers to the head
• hydrocephalus - a neurological condition characterized by the abnormal accumulation of cerebrospinal fluid (CSF) within the brain’s ventricles, leading to an increase in intracranial pressure.
• Hydrocephalus - could also be termed a hydrodynamic CSF disorder
• three main causes for the occurrence of hydrocephalus

  • obstruction
  • poor absorption
  • overproduction
• Non-communicating obstructive hydrocephalus - It happens when there is a blockage or obstruction within the flow of Cerebrospinal fluid (CSF) along the narrow passages that connect the ventricles of the brain it commonly occurs in the aqueduct of Sylvius (aqueductal stenosis)
• It can be congenital (present at birth) or acquired (occurs following birth)

  non-communicating obstructive hydrocephalus
• communicating non obstructive hydrocephalus - This type of hydrocephalus occurs when the flow of Cerebrospinal fluid (CSF) is blocked after leaving the ventricles.
• It is mainly caused by overproduction of CSF, venous drainage insufficiency, and defective absorption of CSF, thus causing increased pressure on the brain or spinal cord.

  non communicating obstructive hydrocephalus
• Two Types of Communicating non obstructive hydrocephalus

  • normal pressure hydrocephalus
  • hydrocephalus ex-vacuo
• can be congenital or acquired

  communicating non-obstructive hydrocephalus
• communicating - able to flow within the ventricles (open)
• cerebrospinal fluid - is the clear and colorless fluid that cushions and protects the spinal cord, brain, and fragile nervous tissue from blows and other trauma.
• Cerebrospinal fluid - circulates through the ventricles and in and around the brain and the cord forming a watery cushion after which it is reabsorbed into the bloodstream
• Signs and Symptoms of Hydrocephalus

  • prominent scalp veins
  • excessively large head circumference
  • bulging of the anterior fontanelles
  • thin and glistening head
  • setting sun sign
• Surgical treatment - is the only effective means of relieving brain pressure and preventing additional damage to the brain tissue
• shunt - long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate.
• Types of shunts

  • ventriculoperitoneal shunt
  • ventriculoatrial shunt
  • lumboperitoneal shunt
  • torkildsen shunt
  • ventriculopleural shunt
• External ventricular shunt - a temporary method of draining cerebrospinal fluid (CSF) from the ventricles in the bra
• Intracranial pressure bolt - A small 3-4mm diameter transducer device inserted into the brain by the neurosurgical team to enable close monitoring of intracranial pressure
• Endoscopic third ventriculostomy - treatment of choice for obstructive hydrocephalus; it involves creating a small opening in the bottom of the third ventricle so that CSF can drain to the 'basal cisterns' below, and from there into the spinal cord, and thus relieve CSF pressure.
• Pharmacologic Treatments

  • diuretics
  • anticonvulsants
  • antibiotics
• Common Diuretics to be given

  • acetazolamide
  • furosemide
• Mannitol - diuretic not to be given to pediatric patient with hydrocephalus
• the frontal are of the head will eventually start to protrude which is called bossing
• common type of shunts

  • ventriculoperitoneal shunt
  • ventriculoatrial shunt
• setting sun sign - an ophthalmologic phe- nomenon where the eyes appear driven downward bilaterally