Hydrocephalus refers to an increase in cerebrospinal fluid (CSF) volume and ventricular enlargement due to disturbances in CSF production, flow, or reabsorption. It can be caused by excessive CSF production, obstructive hydrocephalus due to lesions blocking CSF flow through the ventricles, or communicating hydrocephalus where CSF is not properly reabsorbed. Aqueductal stenosis, where the aqueduct is narrowed, is a common cause of congenital hydrocephalus. Other disorders of CSF flow include normal pressure hydrocephalus and idiopathic intracranial hypertension. Symptoms of increased intracranial pressure include headache, vomiting, decreased consciousness, and vision changes.

1. Hydrocephalus
Done by : Ahmad shurbaji
Khaled hasanen

2. Definition
• Hydrocephalus refers to an increase in
CSF volume and ventricular enlargement
due to disturbance of production, flow or
reabsorption of CSF

3. • The total CSF volume is normally about 150
mL.
• Production from the walls of the ventricles
and the choroid plexus is about 20 mL/hour
• CSF is reabsorbed into the arachnoid villi
along the superior sagittal sinus

5. • CSF flows from the lateral ventricles through
the foramina of Monro to the third ventricle,
then down the cerebral aqueduct to the
fourth ventricle, where it exits to the
subarachnoid space via the midline foramen
of Magendie and the lateral foramina of
Luschka

7. Aetiology of
hydrocephalus
1- Excessive CSF production (rare)
• Choroid plexus papilloma/carcinoma
• 2- Obstructive hydrocephalus
* hydrocephalus—when there is an obstruction to the
flow of CSF through the ventricular system
- Lesions within the ventricle
- Lesions in the ventricular wall
• Lesions distant from the ventricle but with a mass effect

8. • 3 - Communicating hydrocephalus
(failure of reabsorption)
- Post-haemorrhagic
- CSF infection (especially bacterial and tuberculous)
- Raised CSF protein

9. Aqueductal stenosis
• The normal aqueduct measures about 1 mm in
diameter, and is about 11 mm in length
• Is the most common cause of congenital
hydrocephalus(43%).
• Aqueduct develops about the 6th week of gestation
• Prognosis: 11-30% mortality

10. • Intrinsic Pathology of the Aqueduct
- Septum or Membrane Formation :
- A thin membrane of neuroglia may occlude the
aqueduct. It commonly occurs caudally
- There may be a primary developmental defect or it may
follow granular ependymitis from intrauterine infections.
This is the rarest of the types of narrowing
- Forking of the Aqueduct:Typically, there are two
channels seen in midsagittal plane unable to handle CSF
volume. Most often seen with spina bifida

11. • Gliosis of the Aqueduct: Usually of infectious origin
showing a marked gliofibrillary response
• Stenosis of the Aqueduct: Narrowed aqueduct without
evidence of gliosis. This may have hereditary basis

12. sun-setting eye sign

14. Pineal region tumour causing obstructive
hydrocephalus.

15. Disorders of CSF
• Disorders of CSF flow manifest in two syndromes
• 1 - normal pressure hydrocephalus
• 2- idiopathic intracranial hypertension (IIH)

16. 1-normal pressre
hydrocephalus
• The CSF pressure at lumbar puncture (LP) is
typically normal, but it is believed that intermittent
elevations in pressure may be involved in the
aetiology
• This is an important cause of dementia
• It typically presents in older patients with the triad of: -
gait disturbance
- incontinence
- cognitive decline

17. • It may occur de novo or on a background of previous –
subarachnoid haemorrhage (SAH)
- head injury
- meningitis
- tumour

19. 2-Idiopathic intracranial
hypertension
• This condition presents with features of raised
ICP without an underlying tumour
• Old terms for the condition, pseudotumour
cerebri or benign intracranial hypertension.

20. • The patient, typically a young overweight female,
describes a headache typical of raised pressure, and
visual deterioration.
• Examination may reveal papilloedema, and
occasionally cranial nerve palsies
• Imaging is unremarkable, but lumbar puncture
demonstrates a raised opening pressure >25 mmHg

22. • Chronic compensated hydrocephalus is also
commonly seen after craniotomy with breach of
the ventricles

23. symptoms of
raised ICP
 Headache
 Lethargy
 Vomiting
 Decreased consciousness
 weakness
 Numbness
 double vision
 Separated sutures on the
skull ( infant )