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  3. 3. HYDROCEPHALUS The term Hydrocephalus comes from the two Greek words: 'hydro' which means water, and 'cephalus' which means head. In years past, it was commonly called 'water on the brain'. Put simply it is a condition where there is too much cerebrospinal fluid in the cranium
  4. 4. The balance between production and absorption of CSF is critically important. Ideally, the fluid is almost completely absorbed into the bloodstream as it circulates; however, there are circumstances which, when present, will prevent or disturb the production or absorption of CSF, or which will inhibit its normal flow. When this balance is disturbed, hydrocephalus is the
  5. 5.  ANATOMY AND PHYSIOLOGY OF CEREBROSPINAL FLUID  Cerebrospinal fluid (CSF) is found within the brain and the spinal cord. It is a clear, watery substance that flows through a channel into the space (subarachnoid space) around the brain and spinal cord, where it also functions as a cushion. The CSF is absorbed back into the bloodstream via mushroom-like structures over the brain
  6. 6.  A small amount of CSF is produced by the spinal cord. The CSF contains nutrients and proteins necessary for the nourishment and function of the brain and carries waste products away from tissues in and around the
  7. 7. The fluid is produced within hollow channels in the brain called ventricles, primarily within the lateral ventricle. In each ventricle is a specialized structure (which looks like small flower-like tufts) called the choroid plexus, which is responsible for the majority of CSF production
  8. 8. Congenital Hydrocephalus This means that Hydrocephalus is present at birth. It is important to remember that this term does not imply that it is hereditary. Often the exact cause of Congenital Hydrocephalus cannot be determined but known causes can include:
  9. 9. Aqueductal Stenosis (noncommunicating) The most common cause of congenital Hydrocephalus is an obstruction called aqueductal stenosis. When the long, narrow passageway between the third and fourth ventricles (see ‘What is Hydrocephalus’ diagram) is narrowed or blocked, perhaps because of infection, haemorrhage or a tumour. Fluid accumulates "upstream" from the obstruction, producing Hydrocephalus
  10. 10.  Neural Tube Defect or     NTD (communicating) An open NTD, where the spinal cord is exposed at birth and is often leaking CSF, is often referred to as Spina Bifida (see ‘What is Spina Bifida’). This kind of NTD causes part of the cerebellum and the fourth ventricle to push downward through the opening at the base of the skull into the spinal cord area, blocking CSF's flow out of the fourth
  11. 11. Arachnoid Cysts (noncommunicating) Arachnoids' Cysts may occur anywhere in the brain. In children, they're often located at the back of the brain and in the area of the third ventricle. These cysts are filled with CSF and lined with the arachnoid membrane. Some arachnoid cysts are self-contained, while others are connected with the ventricles or the subarachnoid space. The fluid trapped by the cysts may block the CSF pathways, producing
  12. 12. Acquired Hydrocephalus This means that Hydrocephalus has occurred after birth and can be caused by:
  13. 13. Intraventricular Hemorrhage (communicating) An intraventricular haemorrhage, which most frequently affects premature newborns, may cause an acquired form of Hydrocephalus. When small blood vessels alongside the ventricular lining rupture, blood may block or scar the ventricles or plug the arachnoid villi. The arachnoid villi is located in the second layer covering the brain which allows CSF to be absorbed. When the CSF can't be absorbed, Hydrocephalus results.
  14. 14.  Meningitis      (communicating) Meningitis is an inflammation of the membranes of the brain and spinal cord. Caused by a bacterial or (less frequently) viral infection, meningitis can scar the delicate membranes(meninges) that line the CSF pathway. An acquired form of Hydrocephalus may develop if this scarring obstructs the flow of CSF as it passes through the narrow ventricles or over the surfaces of the brain in the subarachnoid space.
  15. 15. Head Injury (communicating) A head injury can damage the brain's tissues, nerves, or blood vessels. Blood from ruptured vessels may enter the CSF pathway, causing inflammation. Sites of CSF absorption might then be blocked by scarred membranes (meninges) or by blood cells. The CSF flow is restricted and Hydrocephalus
  16. 16. Brain Tumours (noncommunicating) In children, brain tumors’ most commonly occur in the back of the brain (posterior fossa). As a tumour grows, it may fill or compress the fourth ventricle, blocking the flow of CSF and causing Hydrocephalus. A tumors somewhere else in the brain might also block or compress the ventricular system
  17. 17. Ventriculitis (noncommunicating) Ventriculitis is a disease causing inflammation and or infection of the ventricles. It is most common in infants and is
  18. 18. CLINICAL MANIFESTATION: The signs and symptoms of hydrocephalus vary generally by age of onset: Infants Common signs and symptoms of hydrocephalus in infants include:  An unusually large head  A rapid increase in the size of the head
  19. 19.  A bulging or tense soft spot        (fontanel) on the top of the head Vomiting Sleepiness Irritability Poor feeding Seizures Eyes fixed downward (sunsetting of the eyes) Deficits in muscle tone and strength, responsiveness to touch, and expected growth
  20. 20. Toddlers and older children Among toddlers and older children, signs and symptoms may include:  Abnormal enlargement of a toddler's head  Headache  Nausea or vomiting  Fever  Delays in walking or talking  Problems with previously acquired skills, such as walking or talking  Blurred or double vision  Unstable balance
  21. 21.          Poor coordination Irritability Change in personality Problems with attention Decline in school performance Poor appetite Seizures Sleepiness Difficulty remaining awake or waking up
  22. 22. Young and middle-aged adults Common signs and symptoms in this age group include: Headache Difficulty in remaining awake or waking up Loss of coordination or balance Loss of bladder control or a frequent urge to urinate Impaired vision Decline in memory, concentration and other thinking skills that may affect job performance.
  23. 23. DIAGNOSTIC EVALUATION: Hydrocephalus is diagnosed through clinical neurological evaluation and by using cranial imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), or pressuremonitoring techniques. A physician selects the appropriate diagnostic tool based on an individual's age, clinical presentation, and the presence of known or suspected abnormalities of the brain or spinal
  24. 24. MANAGEMENT: management for hydrocephalus includes 3 way  Medical management  Surgical management  Nursing management
  25. 25.  Medical treatment is not effective in      long-term treatment of chronic hydrocephalus. It may induce metabolic consequences and thus should be used only as a temporizing measure. Medications affect CSF dynamics by the following mechanisms: diuretics:acetazolamide po,iv decrease production of csf if progress of disease is slow anticonvulsants:Phenobarbital prevents seizures antibiotics:to prevent the shunt infection such as septicemia and meningitis.
  26. 26. SURGICAL MANAGEMENT: Hydrocephalus is most often treated by surgically inserting a shunt system. This system diverts the flow of CSF from the CNS to another area of the body where it can be absorbed as part of the normal circulatory process
  27. 27. VARIOUS TYPES OF SHUNT PROCEDURE  Ventriculoperitoneal shunt (VP shunt)  Ventriculopleural shunt (VPL shunt)  Ventriculoatrial shunt (VA shunt)  Lumboperitoneal shunt (LP shunt)
  28. 28. A shunt is a flexible but sturdy plastic tube. A shunt system consists of the shunt, a catheter, and a valve. One end of the catheter is placed within a ventricle inside the brain or in the CSF outside the spinal cord. The other end of the catheter is commonly placed within the abdominal cavity, but may also be placed at other sites in the body such as a chamber of the heart or areas around the lung where the CSF can
  29. 29. Teach home care Encourage the child to participate in age-appropriate activities as tolerated. Encourage the parents to provide as normal lifestyle as possible. Remind both the child and parents that contact sports are prohibited. Explain how to recognize signs and symptoms of increased ICP. Subtle signs include changes in school performance, intermittent headache, and mild behavior changes. Arrange for the child to have frequent developmental screenings and routine medical checkups.
  30. 30. conclusion: The outlook for the hydrocephalic patient has changed dramatically over the past three decades as physicians caring for them have devoted themselves not only to developing innovative surgical techniques and improved hardware, but also to seeking a normal life-style for their patients.