Hydrocephalus

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  • Aqueductal stenosis-TORCH malformation of aque,aneurysmal diln of vein of Galn
  • Hydrocephalus

    1. 1. MACROCEPHALY ANU PRIYA
    2. 2. MACROCEPHALYHead circumference >2 S.D./>2.5cm above the mean for the age and sexHead circumference >97th percentile for the age and sexExpected HC for a particular child by comparing with standardized charts
    3. 3. Causes Big skull-chronic anemia,osteogenesis imperfecta,rickets Big brain-megalencephaly(tay-sach),cerebral gigantism More CSF in ventricles-hydrocephalus Abnormal accumulation-subdural effusion Familial-commonest cause
    4. 4. HYDROCEPHALUS (Greek-water in head)DEFINITION:Excessive accumulation of CSF in the ventricular system
    5. 5. TYPES OF HYDROCEPHALUSOBSTRUCTIVE OR NON-COMMUNICATING -at the level of aqueduct 3 mm long & 2 mm wideNON OBSTRUCTIVE OR COMMUNICATING -increased production -decreased absorption
    6. 6. CAUSES OF HYDROCEPHALUSCOMMUNICATING HYDROCEPHALUSIncreased Production• Tumors in choroid plexusDecreased AbsorptionCongenital-TORCHAcquired-Meningitis,leukemia
    7. 7. CAUSES OF HYDROCEPHALUS• OBSTRUCTIVE HYDROCEPHALUSCongenitalAqueductal stenosisArnold chiari syndromeDandy-walker syndromeAcquiredAqueductal gliosis-meningitis,bleeding,mumps encephalitisPosterior fossa tumors-medulloblastoma
    8. 8. CLINICAL MANIFESTATIONS SYMPTOMS: IRRITABILITY POOR FEED LETHARGY VOMITING
    9. 9. CLINICAL MANIFESTATIONSSIGNS:Before AF closure -BULGING ANTERIOR FONTANEL, -INCREASED HEAD CIRC. -DILATED SCALP VEINS -SETTING SUN SIGN -WEAKNESS OF LOWER LIMBS
    10. 10. • After AF closure-Headache,vomiting-Blurring of vision-Bradycardia,increased Bp-6th CN Palsy-Papilloedema-Transillumination Test-Macewen Sign “Cracked Pot”-Prominent Occiput (Dandy-walker)
    11. 11. DIAGNOSISHistory1.Prematurity2.Intrauterine infections3.Intracranial hemorrhage4.Meningitis5.Mumps encephalitis
    12. 12. On examination1.Café-au-lait patches2.Spinal dysmorphism3.Wide AF,wide sutures,sunset eye sign4.Lower limb weakness,cranial bruit5.Chorioretinitis,papilloedema
    13. 13. IMAGING STUDIESPLAIN X-RAY SKULL: SEPARATION OF SUTURES EROSION OF POSTERIOR CLINOIDS INCREASED CONVOLUTIONAL MARKINGS (SILVER BEATEN APPEAREANCE)ULTRASOUNDCT SCANMRI
    14. 14. TREATMENTSUPPORTIVE:(control of ICP)a.head elevated to 30ob.Control of temperaturec.Control of seizuresd.Maintain BPe.Analgesia and sedation
    15. 15. TREATMENTMEDICAL: (for decreasing the production) _ MANNITOL/ORAL GLYCEROL -ACETAZOLAMIDE -FUROSEMIDESURGICAL:(for obstruction and decreased absorption) V-P SHUNT PLACEMENT
    16. 16. PROGNOSISINCREASED RISK FOR DEVELOPMENTAL DISABILITIESMEAN IQ IS REDUCED COMPARED TO GENERAL POPULATIONABNORMALITIES IN MEMORYSOME PATIENTS SHOW AGGRESSIVE OR DELINQUENT BEHAVIOR.
    17. 17. PROGNOSISVISUAL PROBLEMS: STRABISMUS VISUOSPATIAL ABNORMALITIES DECREASED VISUAL ACUITY VISUAL FIELD DEFECTSPATIENTS REQUIRE LONG TERM FOLLOW UP

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