Hydrocephalus

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Hydrocephalus

  1. 1. HYDROCEPHALUS Rene Santin, M.D. Texas Tech University Health Sciences Center Department of Pediatrics
  2. 2. HYDROCEPHALUS <ul><li>DEFINITION: </li></ul><ul><li>DIVERSE GROUP OF CONDITIONS WHICH RESULT FROM IMPAIRED CIRCULATION AND RESORPTION OF CSF. </li></ul>
  3. 3. CSF FORMATION <ul><li>CSF IS FORMED BY THE CHOROID PLEXUS. </li></ul><ul><li>NORMAL CSF PRODUCTION: 20 ml/h. </li></ul>
  4. 4. TYPES OF HYDROCEPHALUS <ul><li>OBSTRUCTIVE OR NON-COMMUNICATING (OBSTRUCTION WITHIN THE VENTRICULAR SYSTEM) </li></ul><ul><li>NON OBSTRUCTIVE OR COMMUNICATING (MALFUNCTION OF ARACHNOID VILLI) </li></ul>
  5. 5. CAUSES OF HYDROCEPHALUS <ul><li>LESIONS OR MALFORMATIONS OF THE POSTERIOR FOSSA </li></ul><ul><ul><li>CHIARI MALFORMATION </li></ul></ul><ul><ul><li>DANDY- WALKER SYNDROME </li></ul></ul><ul><ul><li>TUMORS </li></ul></ul><ul><li>IVH </li></ul><ul><li>MENINGITIS: PNEUMOCOCCAL, TB </li></ul><ul><li>INTRAUTERINE INFECTIONS </li></ul>
  6. 6. PATHOLOGY <ul><li>AQUEDUCTAL STENOSIS: </li></ul><ul><ul><li>ABNORMALLY NARROW AQUEDUCTUS OF SYLVIUS. </li></ul></ul><ul><li>AQUEDUCTAL GLIOSIS: </li></ul><ul><ul><li>BRISK GLIAL RESPONSE OF EPENDIMAL LINING </li></ul></ul>
  7. 7. CHIARI MALFORMATION <ul><li>TYPE I: </li></ul><ul><ul><li>DISPLACEMENT OF CEREBELLAR TONSILS INTO THE CERVICAL CANAL. </li></ul></ul><ul><ul><li>GIVES SYMPTOMS IN ADOLESCENCE OR ADULT LIFE. (HEADACHE, NECK PAIN) </li></ul></ul><ul><ul><li>NO HYDROCEPHALUS . </li></ul></ul>
  8. 8. CHIARI MALFORMATION <ul><li>TYPE II : </li></ul><ul><ul><li>PROGRESSIVE HYDROCEPHALUS AND MYELOMENINGOCELE. </li></ul></ul><ul><ul><li>ELONGATION OF THE 4TH VENTRICLE. </li></ul></ul><ul><ul><li>DISPLACEMENT OF INFERIOR VERMIS, PONS, AND MEDULLA INTO CERVICAL CANAL </li></ul></ul>
  9. 9. DANDY-WALKER SYNDROME <ul><li>CYSTIC EXPANSION OF THE 4TH VENTRICLE IN THE POSTERIOR FOSSA. </li></ul><ul><li>DEVELOPMENTAL FAILURE OF ROOF OF 4TH VENTRICLE DURING EMBRYOGENESIS. </li></ul><ul><li>90 % HAVE HYDROCEPHALUS </li></ul><ul><li>PROMINENT OCCIPUT </li></ul>
  10. 10. IVH <ul><li>DEFINITION: </li></ul><ul><ul><li>BLEEDING IN SUBEPENDIMAL GERMINAL MATRIX WITH/WITHOUT EXTENSION INTO VENTRICLES AND BRAIN PARENCHYMA </li></ul></ul><ul><li>INCIDENCE: </li></ul><ul><ul><li>IN PREMATURES 25 - 40 % </li></ul></ul>
  11. 11. IVH <ul><li>PATHOLOGY: </li></ul><ul><ul><li>INTRAVASCULAR </li></ul></ul><ul><ul><li>VASCULAR </li></ul></ul><ul><ul><li>EXTRAVASCULAR </li></ul></ul><ul><li>COMPLICATIONS: </li></ul><ul><ul><li>HYDROCEPHALUS </li></ul></ul><ul><ul><ul><li>20 % IN MODERATE BLEEDS </li></ul></ul></ul><ul><ul><ul><li>65-100 % IN LARGE BLEEDS. </li></ul></ul></ul>
  12. 12. PREVENTION OF IVH <ul><li>AVOID PROLONGUED LABOR OR DIFFICULT VAGINAL DELIVERY </li></ul><ul><li>AVOID PNEUMOTHORAX </li></ul><ul><li>AVOID OF HYPOTENSION OR HYPERTENSION IN THE NEONATE </li></ul><ul><li>AVOID HYPOXIC ISCHEMIC INSULT </li></ul>
  13. 13. PREVENTION OF IVH <ul><li>INDOMETHACIN </li></ul><ul><li>PROPHYLACTIC FFP?? </li></ul><ul><li>PROPHYLACTIC PLATELET TRANSFUSION??? </li></ul><ul><li>PHENOBARBITAL??? </li></ul><ul><li>VITAMIN E ??? </li></ul>
  14. 14. CLINICAL MANIFESTATIONS <ul><li>SYMPTOMS: </li></ul><ul><ul><li>IRRITABILITY </li></ul></ul><ul><ul><li>POOR FEED </li></ul></ul><ul><ul><li>LETHARGY </li></ul></ul><ul><ul><li>VOMITING </li></ul></ul><ul><ul><li>IN OLDER PATIENTS: </li></ul></ul><ul><ul><ul><li>HEADACHE </li></ul></ul></ul><ul><ul><ul><li>CHANGES IN PERSONALITY </li></ul></ul></ul><ul><ul><ul><li>ACADEMIC DETERIORATION </li></ul></ul></ul>
  15. 15. CLINICAL MANIFESTATIONS <ul><li>SIGNS: </li></ul><ul><ul><li>ANTERIOR FONTANEL WIDE OPEN AND BULGING, INCREASED HEAD CIRC. </li></ul></ul><ul><ul><li>DILATED SCALP VEINS </li></ul></ul><ul><ul><li>SETTING SUN SIGN </li></ul></ul><ul><ul><li>BRISK TENDON REFLEXES, SPASTICITY </li></ul></ul><ul><ul><li>CLONUS, BABINSKY </li></ul></ul><ul><ul><li>MACEWEN SIGN “CRACKED POT” </li></ul></ul><ul><ul><li>PROMINENT OCCIPUT (DANDY-WALKER) </li></ul></ul>
  16. 16. IMAGING STUDIES <ul><li>X-RAY PLAIN FILMS: </li></ul><ul><ul><li>SEPARATION OF SUTURES </li></ul></ul><ul><ul><li>EROSION OF POSTERIOR CLINOIDS </li></ul></ul><ul><ul><li>INCREASED CONVOLUTIONAL MARKINGS (BEATEN SILVER APPEAREANCE) </li></ul></ul><ul><li>ULTRASOUND </li></ul><ul><li>CT SCAN </li></ul><ul><li>MRI </li></ul>
  17. 17. THERAPY <ul><li>MEDICAL: </li></ul><ul><ul><li>ACETAZOLAMIDE </li></ul></ul><ul><ul><li>FUROSEMIDE </li></ul></ul><ul><li>SURGICAL: </li></ul><ul><ul><li>V-P SHUNT PLACEMENT </li></ul></ul>
  18. 18. PROGNOSIS <ul><li>INCREASED RISK FOR DEVELOPMENTAL DISABILITIES </li></ul><ul><li>MEAN IQ IS REDUCED COMPARED TO GENERAL POPULATION </li></ul><ul><li>ABNORMALITIES IN MEMORY </li></ul><ul><li>SOME PATIENTS SHOW AGGRESSIVE OR DELINQUENT BEHAVIOR. </li></ul>
  19. 19. PROGNOSIS <ul><li>VISUAL PROBLEMS: </li></ul><ul><ul><li>STRABISMUS </li></ul></ul><ul><ul><li>VISUOSPATIAL ABNORMALITIES </li></ul></ul><ul><ul><li>DECREASED VISUAL ACUITY </li></ul></ul><ul><ul><li>VISUAL FIELD DEFECTS </li></ul></ul><ul><li>PATIENTS REQUIRE LONG TERM FOLLOW UP (MULTIDISCIPLINARY) </li></ul>

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