Neurologic Disorders

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Enj Rey

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  • CLASSIFICATIONS:
    1. Obstructive, Intraventricular
    ● Flow of CSF from ventricles to subarachnoid space is obstructed.
    ● Example is when a child has a tumor.

    2. Communication, Extraventricular
    ● Flow is not obstructed, but CSF is inadequately reabsorbed in subarachnoid space and reaches the spinal cord.
    ● Example is when the child has meningitis, the subarachnoid space is within the meninges
  • 3. Congenital
    ● Occurs at birth.
    ● Cause is generally unknown, although maternal infection may be a factor.
    4. Acquired
    ● From an incident later in life.
    ● It could be again from meningitis, brain tumor also head injury and other possible causes
  • ASSESSMENT:
    1. Enlarging head size
    2. Bulging, non-pulsating, wide, and tensed fontanelles
    3. Suture lines separate
    4. Scalp becomes shiny and scalp veins become prominent
    5. Brow bulges forward, bossing
  • 6. Sunset eyes as sclera shows above the iris because of upper lid retraction, downward rotation of eyes
    7. Poor feeding, vomiting, lethargy, irritability
    8. Shrill, high-pitched cry
    9. Abnormal muscle tone
    10. Increased intracranial pressure such as decreased pulse and respirations, increased temperature and blood pressure, hyperactive reflexes, strabismus, and optic atrophy
    ● For the diagnostic test, the photo visualizes excess CSF as evidenced by the darker color. A CT scan, MRI, and skull xray can show this and they can also reveal separating sutures and thinning of the skull
  • DIAGNOSTIC TESTS:
    ● A CT scan, MRI, and skull x-ray can show hydrocephalus and reveal separating sutures and thinning of skull.
    ● Transillumination, holding a bright light such as a flashlight or a specialized light against the skull in a darkened room, will reveal the skull is filled with fluid rather than solid brain
  • MANAGEMENT:
    Management of the hydrocephalus depends on its cause and extent
    ● If cause is CSF overproduction:
    1. Giving of ACETAZOLAMIDE (DIAMOX), to promote the excretion of excess fluid.
    ● This drug is a diuretic
  • 3. Removal of tumor in the area if it responsible for CSF overproduction
    ● These could be through craniotomy the tumor compresses the choroid plexus and causes the increased CSF production, so if tumor is removed the area will be relieved of compression and will not produce excess CSF
  • If cause is obstruction:
    4. Laser surgery to reopen the route of flow.
    ● uses lasers beam to cut tissues
  • 5. Ventriculoperitoneal shunting to bypass point of obstruction in ventricles to point of absorption in peritoneum. This involves insertion of a flexible catheter under the skin from the ventricles to the peritoneum.
    ● Most common management for hydrocephalus
    ● The shunt drains excess CSF from the brain and that fluid is absorbed by another organ, which is peritoneal cavity
  • ● This catheter has to be replaced as the child grows old or it will become too short and cannot absorb CSF anymore. Other than that, the child will again show signs of increased ICP which mean the shunt is not functioning anymore.
    ● As another complication since there is an implanted foreign body it can become infected so watch out for those signs, also signs of peritonitis
  • 6. Ventricular endoscopy as an alternative to VP shunt, to relieve obstruction within ventricles
    ● Again, it’s an alternative to VP shunt, this can relieve obstruction within the ventricles as of now this procedure is being perfected so maybe the next generation of hydrocephalus won't need VP shunt anymore, unlike in VP shunt there is implanted foreign body in Ventricular endoscopy
  • Hydrocephalus Management if cause is CSF overproduction:
    1. Give acetazolamide to promote the excretion of excess fluid.
    2. Ventricular endoscopy to destroy portion of choroid plexus
    3. Removal of tumor through craniotomy
  • Hydrocephalus Management if cause is obstruction:
    1. Laser surgery to reopen the route of flow
    2. Ventriculoperitoneal shunting to bypass point of obstruction in ventricles to point of absorption in peritoneum
    3. Ventricular endoscopy as an alternative to VP shunt, to relieve obstruction within ventricles