Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain. Cerebrospinal fluid normally flows through the ventricles and bathes the brain and spinal column.

1. HYDROCEPHALUS
DEVENDRA SINGH
MPT NEUROLOGY

2. LEARNING OUTCOMES
At the end of the session the students are able to describe the:
Definition
Etiology/ Classification
Pathology
Clinical features
Investigations
Management DEVENDRA SINGH
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3. CONTENTS
 Overview of ventricular system
 Definition
 Etiology/ Classification
 Pathology
 Clinical features
 Investigations
 Management
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8. Definition
 “Water in the brain”
 Hydro - "water", kephalos - "head“
 Abnormal accumulation of CSF in the ventricles or cavities of the
brain
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9. Causes
 Congenital or acquired
 Communicating - Reabsorption, or excessive CSF production
 Non-communicating (obstructive)- Impaired CSF flow
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11. Obstructive hydrocephalus
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12. Communicating
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13. Pathology
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16. Hydrocephalus arrest
 Ventricle remain dilated
 ICP returns to normal
 CSF absorption appears to balance production
 Normal developmental patterns returns
 Pre existing mental and physical damage leads to
permanent handicap
 Any further infection or injury leads to unstable
again
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18. Clinical features
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19. DEVENDRA SINGH 19

20. Impairments
 Acute dilatation - Nonspecific signs and symptoms
 Chronic dilatation – Hakims triad (Adams triad)
 Increased ICP
 Headache, vomiting, Nausea, papilledema, sleepiness or coma
 Uncal or cerebellar tonsil herniation, - brainstem compression
 Hakim's triad –dementia, urinary incontinence, gait instability
 Focal neurological deficits parinaud syndrome
 Fontanelle to bulge -head to be larger than expected.
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21. DEVENDRA SINGH 21

22. Investigations
 Skull x ray
 CT Scan
 MRI
 Ultrasonography
 ICP monitoring
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25. Surgical intervention
 Ventriculoperitonial shunt
 Ventriculo atrial shunt
 Ventriculo plural shunt
 Lumbar peritoneal shunt
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29. DEVENDRA SINGH 29

30. Signs and symptoms of shunt malfunction
Sign and symptom Infants Toddler School age children
Bulging fontanella X
Sunset sign of eye X
Excessive rate of growth of head
circumference
X
Thinning of skin over scalp X
Irritability X X X
Seizures X X X
Vomiting X X X
Lethargy X X X
Headaches X X
Edema, redness along shunt tract X X X
Personality changes X
Memory changes X
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31. Physical therapy assessment
& intervention
 PRE OPERATIVE AND POST OPERATIVE
ASSESSMENT
INTERVENTION
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