This document discusses hydrocephalus, which is characterized by dilated cerebral ventricles and increased CSF pressure. It can be congenital or acquired. CSF is produced by the choroid plexus and normally absorbed by arachnoid villi. In hydrocephalus, there is an accumulation of CSF in the ventricles causing their dilation and compression of brain tissue. It can be classified as communicating or obstructive. Clinical features include increased head circumference, fontanel bulging, irritability, and vomiting in infants. Diagnosis involves imaging like ultrasound, CT scan, or MRI. Treatment involves medical management with drugs to reduce CSF production or pressure, or surgical placement of a shunt to drain CSF from the ventricles

1. HYDROCEPHALUS
By
Mr. Ravi Rai Dangi
Assistant Professor
Fellowship in Neonatal Nursing
MSc. Child Health Nursing

2. HYDROCEPHALUS
 Hydrocephalus is characterized by dilatation of the
cerebral ventricles and increased CSF pressure .
 Incidence :- 2 out of 1000

3. ETIOLOGY
 Congenital
 Acquired

4. CSF FLOW
 CSF is predominantly formed by the choroid plexus of the lateral, third
and fourth ventricles by an active transport process across the
endothelium of capillaries in the villous process of the choroid plexus.
 The arachnoids villus is the primary site of CSF absorption.

5. PATHOPHYSIOLOGY
Etiological factors
Accumulation of CSF in the ventricular system
Dilatation of ventricles
Compression of the brain tissue against the
Surrounding bony cranium

6. PATHOPHYSIOLOGY
 Before the cranial sutures are fused in young infants
, the skull may be able to expand to accommodate
gradual increase in volume.
 With fusion of sutures the skull can no longer
enlarges and ove signs of increasing ICP indicates
the presence of hydrocephalus

7. CLASSIFICATION
 Non obstructive, or communicating
Hydrocephalus occurs when the CSF flows out of
the chambers of the brain (ventricles) and into
the spinal canal, but it is not reabsorbed normally
by the tissue surrounding the brain and spinal
cord. Sometimes this type of hydrocephalus
corrects itself.

8. CLASSIFICATION
Obstructive, or non communicating,
Hydrocephalus occurs when the CSF does
not flow properly between or out of the
brain ventricles because of an obstruction,
such as from a malformation or narrowing.

9. CLINICAL FEATURES
 Early onset
Vomiting
Drowsiness
Irritable
Increase head circumference

10. CLINICAL FEATURES
 Frontal bossing
 Anterior fontanels is widely open
 Sunset sign

11. CLINICAL FEATURES
Late Onset-
 Pappiledema (Optic disc swelling that is caused by increased
intracranial pressure due to any cause)
 Head ache
 Vomiting
 Mc Ewen’s sign (Percussion on the skull at a particular spot (near the
junction of the frontal, temporal and parietal bones) yields an unusually
resonant sound in the presence of hydrocephalus or a brain abscess.)

12. DIAGNOSTIC FEATURES
 Ultrasonography
 CT scan
 MRI

13. TREATMENT
GOALS
 Decreasing intracranial pressure
 Maximizing the potential for neurological development.

14. TREATMENT
 Medical therapy
1. In communicating
Acetazolamide (50-100mg/kg/day )( To decrease
the production of CSF )
Furosemide
Mannitol is given to decrease the intracranial
pressure.

15. SURGICAL MANAGEMENT
 Shunt surgery
1. Ventriculoperitoneal shunt
In this shunt is placed between the enlarged
ventricle that drains out csf in to the peritoneal
cavity

17. Nursing management
Preoperative care
1. Assess the signs of increased intracranial pressure.
2. Maimane of nutrition
3. Risk for injury
4. Parenteral anxiety

18. Nursing management
 Post operative care
1. Assessment of vital signs
2. Assess for increased ICP.
3. Treat for infection
4. Parent education

19. COMPLICATION
 Subdural hematoma
 Infection
 Malfunctioning of the tube
 Constipation