Hydrocephalus Lecture Note (Congenital and Acquired)
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This document discusses hydrocephalus, beginning with an introduction defining it as abnormal collection of cerebrospinal fluid within the brain ventricles due to overproduction, obstruction of flow, or decreased absorption. It then covers the epidemiology, relevant anatomy of cerebrospinal fluid flow, etiology which can be congenital or acquired, classification as obstructing or communicating, clinical features in infants and adults, investigations including CT scan, and treatment which is typically surgical using shunts to redirect cerebrospinal fluid flow, with ventriculoperitoneal shunt being most common. Complications of shunt surgery like failure, blockage, and infection are also discussed.
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Intussusception is the telescoping of one part of the intestine into another part and is most common in children under 2 years old. The classic presentation includes intermittent abdominal pain, a sausage-shaped abdominal mass, and currant jelly stools. Ultrasound is the preferred diagnostic method and shows a target or "doughnut" sign. Treatment involves rehydration and antibiotics if infected. Non-operative reduction using hydrostatic or pneumatic pressure is usually attempted first but surgery may be needed if reduction fails or there are signs of perforation or necrosis. With prompt diagnosis and treatment, mortality from intussusception is less than 1%.
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HYDROCEPHALUS
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Hydrocephalus
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The choroid plexus located within the brain ventricles produces cerebrospinal fluid (CSF) which circulates through the ventricular system. Hydrocephalus is an abnormal accumulation of CSF within the brain that can be caused by issues with CSF production/absorption or blockages in the CSF pathways. It results in ventricle dilation and head enlargement. Hydrocephalus is classified as congenital or acquired, and as communicating or non-communicating depending on whether CSF can circulate freely. Symptoms vary by age but include head growth, vomiting, irritability, and cognitive decline. Diagnosis involves imaging and ruling out other conditions. Treatment options include medical management to reduce CSF or surgical procedures like shunts to
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Hydrocephalus is a condition caused by an imbalance in cerebrospinal fluid circulation and absorption in the brain, which leads to excessive accumulation of fluid in the ventricles and increased intracranial pressure. It can be congenital due to malformations or acquired from infections, tumors, or hemorrhages. The excess fluid causes ventricle dilation and brain compression. Treatment involves surgical placement of a shunt to drain fluid from the ventricles to the abdominal cavity or heart. Complications include shunt malfunction and infection. Spina bifida is a neural tube defect where the spine fails to close, often with a visible sac-like protrusion of membranes and spinal cord. It can cause paralysis, in
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This document discusses several pediatric neurological disorders including hydrocephalus, spina bifida, and bacterial meningitis. Hydrocephalus is an abnormal buildup of cerebrospinal fluid in the brain ventricles which can cause increased intracranial pressure. It is usually treated with surgical insertion of a shunt system to drain fluid from the brain. Spina bifida is a birth defect involving incomplete closing of the spinal column which can range from mild to severe. Bacterial meningitis is a medical emergency caused by bacterial infection of the meninges and cerebrospinal fluid, with symptoms including fever, irritability, and neck stiffness.
Hydrocephalus
Hydrocephalus is a condition where cerebrospinal fluid builds up in the brain, increasing pressure inside the skull. It can be congenital, acquired after birth from injuries or infections, or develop later in life. Symptoms depend on age but include headaches, nausea, vision issues, and cognitive or mobility problems. Treatment involves surgically inserting a shunt to drain fluid from the brain ventricles to other body areas. Complications can arise from shunt malfunctions or progression of the condition if left untreated.
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Hydrocephalus. BS Nursing.
Hydrocephalus is a condition characterized by the excessive accumulation of cerebrospinal fluid (CSF) within the brain ventricles. This buildup of CSF increases intracranial pressure and causes the ventricles to dilate, potentially damaging the brain. Hydrocephalus can be congenital due to genetic factors or acquired later in life due to infections, tumors, or hemorrhages that obstruct CSF flow. Common signs include an abnormally enlarging head size, bulging fontanel, downward eye deviations, and poor feeding in infants. Left untreated, hydrocephalus can cause brain damage or death.
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Hydrocephalus Lecture Note (Congenital and Acquired)
- 1. HYDROCEPHALUS GBONEME S.E FINAL YEAR, MEDICAL STUDENT, CMUL
- 2. Outline • Introduction • Epidemiology • Relevant Anatomy • Etiology • Classification and Pathogenesis • Clinical Features • Management
- 3. Introduction • Hydrocephalus is of major importance as it is commonly noticed in children, as well as after a traumatic brain injury • Hydrocephalus can be defined as the abnormal collection of cerebrospinal fluid within the ventricles of the brain either due to over production of CSF, obstruction of flow, or decreased absorption.
- 4. Epidemiology • Hydrocephalus occurs in approximately every 1 in 500 children. • It has equal sex predilection (i.e. a ratio of 1:1) • No racial predilection. • Also occurs after Head Injury.
- 6. Relevant Anatomy Contd • CSF is produced by the choriod plexuses of the ventricles. • It flows from the Lateral ventricles (2) to the 3rd ventricle via the FORAMEN OF MONROE (2) then flows into the 4th ventricle via the AQUEDUCT of SYLVIUS. • From the 4th Ventricle, it flows into the CISTERNS via the lateral FORAMEN OF LUSCHKA (2) and the median FORAMEN OF MAGENDIE (1)
- 7. Relevant Anatomy Contd • CSF from the foramen of Luschka flows into the pontine cistern, then the lumbar cistern • CSF from the foramen of Magendie flows into the superior cistern. • CSF from the lumbar cistern and superior cistern join and flow into the SUBARACHNOID SPACE. • There, they are then absorbed by the arachnoid villi granulations.
- 8. Relevant Anatomy Contd • Absorbed CSF flows to the CONFLUENCE OF SINUS and drains into venous blood via the STRAIGHT SINUS.
- 9. Etiology • Grouped into CONGENITAL and ACQUIRED • CONGENITAL Aqueduct of Sylvius stenosis Arnold Chiari II malformation Stenosis of any of the foramina Dandy walker syndrome Fetal and Neonatal infections e.g Toxoplasmosis
- 10. Etiology Contd • ACQUIRED Trauma Infection- Bacterial meningitis, ventriculitis Neoplasms – Choriod Papilloma Hemorrhage – Intracranial hemorrhage
- 11. Classification • Can broadly be classified as Obstructing (Non communicating) and Communicating. • Non communicating: Flow of CSF is blocked along one or more of the narrow pathways in the ventricular system • Communicating: Flow is not blocked within the ventricular system, however it can be blocked after it exits the ventricular system.
- 12. Clinical Features • Hydrocephalus in Infants: 1. Failure to thrive 2. Failure to achieve milestones 3. Distended scalp veins 4. Increased skull circumference 5. Lethargy 6. Vomiting 7. Sun setting of eyes (due to 3rd ventricle compression on the superior colliculus) 8. Tense and Bulging fontanelle
- 13. Clinical Features contd • Hydrocephalus in Adults 1. Headaches – Usually in the morning, due to raised ICP due to CO2 retention, causing vasodilatation. Raised ICP causes compression of pain sensitive dura. 2. Vomiting, (projectile) also in the morning, relieves the headache. Occurs due to compression of the Chemoreceptor trigger zone. 3. Drowsiness 4. Papilloedema - Optic disc edema 5. Cushings Triad – Hypertension, Bradycardia, Cheyne stokes breathing (A late sign)
- 14. Managment • Investigations 1. Plain X-RAY (although phased out, but may show Copper beating appearance of the skull).
- 15. Investigations contd • CT Scan: • Investigation of choice. Shows the size of the ventricles as well as the underlying cause and the degree of mass effect. • Other investigations • Full Blood Count – may indicate Infection (raised WBC) • Also necessary for surgery work up • Electrolyte, Urea, Creatinine – Baseline, work up for surgery
- 18. Treatment • Treatment is SURGICAL. Treat the underlying cause
- 19. Treatment contd • Redirect CSF flow using Shunts 1. Ventriculoperitoneal – most common 2. Ventriculoatrial 3. Lumboperitioneal 4. Ventriculopleural • Endoscopic third ventriculostomy
- 20. Complication • VP shunt comes with quite a number of complications. • 1. The shunt can fail • 2. Blockage of the shunt can occur • 3. Infections may arise
- 21. Thank You.