Introduction Of Hydrocephalus Cause Of Hydrocephalus Signs and Symptoms Of Hydrocephalus Diagnosis Of Hydrocephalus Possible Complications Of Hydrocephalus? Diagnostic tests Treatment Shunt surgery The operation

1. Prepared By:-
1-Aram Mustafa Ali 2-Narnj Wasman Saeed 3-Daroon Abdulrahman Abdulla
Supervised by:-
M. Handren
M. Shaho
Hydrocephalus
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2. Outline
 Introduction Of Hydrocephalus
 Cause Of Hydrocephalus
 Signs and Symptoms Of Hydrocephalus
 Diagnosis Of Hydrocephalus
 Possible Complications Of Hydrocephalus?
 Diagnostic tests
 Treatment
 Shunt surgery
 The operation
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3. Hydrocephalus
Hydrocephalus can be defined broadly as a disturbance of
cerebrospinal fluid (CSF) formation, flow, or absorption,
leading to an increase in volume occupied by this fluid in
the central nervous system (CNS). This condition could also
be termed a hydrodynamic CSF disorder.
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4. Hydrocephalus, also called
water in the brain, is a
condition where there is an
abnormal build up of CSF
(cerebrospinal fluid) in the
cavities (ventricles) of the brain.
The build-up is often caused by
an obstruction that prevents
proper fluid drainage.
Cause Of Hydrocephalus4

5. Causes of acquired hydrocephalus may include:
1. Tumor
2. Infection
3. Prematurity
4. Bleeding inside the head
5. Birth injury
6. Abnormal blood vessel formation
inside of the head
7. Trauma
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6. Signs and symptoms
 Clinical features of hydrocephalus are influenced by the patient's age, the cause of the hydrocephalus,
the location of the obstruction, its duration, and its rapidity of onset.
 Symptoms in infants include poor feeding, irritability, reduced activity, and vomiting.
 Symptoms in children and adults include the following:
1. Slowing of mental capacity, cognitive deterioration
2. A full or bulging fontanel (soft spot located on the top of the head)
3. Increasing head circumference (size)
4. Headaches (initially in the morning)
5. Neck pain, suggesting tonsillar herniation
6. Projectile Vomiting, more significant in the morning
7. Bulging eyes and an inability of the baby to look upward with the head facing forward
8. Blurred vision: A consequence of papilledema and, later, of optic atrophy
9. Double vision: Related to unilateral or bilateral sixth nerve palsy
10. Difficulty in walking
11. Drowsiness
12. Seizures
13. Developmental delays
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7. Possible Complications Of Hydrocephalus?
1. Visual changes
 Occlusion of posterior cerebral arteries secondary to downward
transtentorial herniation
 Chronic papilledema injuring the optic disc
 Dilatation of the third ventricle with compression of optic chiasm
2. Cognitive dysfunction
3. Incontinence
4. Giat changes
5. Electrolyte imbalance
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8. Diagnosis
 Examination in infants may reveal the following findings:
1. Head enlargement (head circumference ≥98th percentile for age), especially crossing
percentiles on the growth chart
2. Disjunction/splaying of sutures
3. Dilated scalp veins
4. Tense/bulging fontanelle
5. Setting-sun sign: Characteristic of increased intracranial pressure (ICP); downward
deviation of the ocular globes, retracted upper lids, visible white sclera above irises
6. Increased limb tone (spasticity preferentially affecting the lower limbs)
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9. Diagnosis
 Children and adults may demonstrate the following findings on physical
examination:
1. Papilledema (optic nerve swelling), although this does not develop acutely
2. Failure of upward gaze: Due to pressure on the tectal plate through the
suprapineal recess; the limitation of upward gaze is of supranuclear origin
3. Unsteady gait
4. Large head
5. Unilateral or bilateral sixth nerve palsy (secondary to increased ICP)
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10. Diagnostic tests
 Ultrasound
 Magnetic resonance imaging (MRI)
 Computed tomography (CT) scan
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11. Treatment
 Babies born with hydrocephalus (congenital) and adults or children who
develop it (acquired) usually need prompt treatment to reduce the
pressure on their brain.
 If hydrocephalus isn't treated, the increase in pressure will cause brain
damage.
 Both congenital and acquired hydrocephalus are treated with either shunt
surgery or neuroendoscopy.
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12. Shunt surgery
 During shunt surgery, a thin
tube called a shunt is implanted
in the brain. The excess
cerebrospinal fluid (CSF) in the
brain flows through the shunt to
another part of the body, usually
the tummy. From here, it's
absorbed into your bloodstream.
 Inside the shunt there's a valve
that controls the flow of CSF and
ensures it doesn't drain too
quickly. You can feel the valve as
a lump under the skin of your
scalp.
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13. The operation
 Shunt surgery is carried out by a neurosurgeon, a specialist in brain and
nervous system surgery. The procedure is carried out under general
anesthetic and usually takes one to two hours.
 You may need to stay in hospital for a few days after the operation to
recover.
 If you have stitches, they may dissolve or need to be removed. Some
surgeons use skin staples to close the wound, which will need to be
removed after a few days.
 After the shunt has been installed, further treatment for hydrocephalus
may be needed if it becomes blocked or infected. Shunt repair surgery will
then be necessary.
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 https://www.youtube.com/user/arammustafa85
 For more information you can see video about hydrocephalus in my channel

15. NURSING CARE PLAN - Hydrocephalus
Nursing Interventions Rationale
1-Assess vital signs hourly, noting for any irregularity in breathing
breathing and heart rate and rhythm and measure the pulse
pressure.
Monitoring vital signs closely to recognize early signs of increased
increased intracranial pressure
2-Assess neurological status (such as mental status, motor, and
balance, reflexes (for newborns and infant)
These assessments will determine changes in child neurological
conditions associated with ICP
3-Examine the pupils by noting its size, shape, equality, and position
position of the pupils, and their response to light.
Pupil reaction which is controlled by the cranial nerve III
(Oculomotor nerve) is beneficial for assessing brain stem function.
4-Measure the client’s head circumference and appearance of
anterior fontanelle.
Head circumference, if increasing, or a tense bulging fontanelle
reveals CSF accumulation.
5-Elevate the head of the bed gradually about 15-45 degrees as
indicated. Maintain the client’s head in neutral position.
This position will reduce arterial pressure by promoting venous
drainage and enhance cerebral perfusion.
6-Provide oxygen therapy as needed. Supplemental oxygen decreases hypoxemia levels which may
improve cerebral vasodilation and blood volume.
7-Administer diuretics corticosteroids as ordered. Acetazolamide (Diamox) and furosemide (Lasix) may control
communicating hydrocephalus by reducing production
of cerebrospinal fluid; Corticosteroids reduce inflammation.
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16. References
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 Kahlon B, Annertz M, Stahlberg F, Rehncrona S. Is aqueductal stroke volume, measured with cine phase-
contrast magnetic resonance imaging scans useful in predicting outcome of shunt surgery in suspected normal
pressure hydrocephalus?. Neurosurgery. 2007 Jan. 60(1):124-9; discussion 129-30. [Medline].
 Hattingen E, Jurcoane A, Melber J, Blasel S, Zanella FE, Neumann-Haefelin T. Diffusion tensor imaging in
patients with adult chronic idiopathic hydrocephalus. Neurosurgery. 2010 May. 66(5):917-24. [Medline].
 Hamilton MG. Treatment of hydrocephalus in adults. Semin Pediatr Neurol. 2009 Mar. 16(1):34-41. [Medline].
 Kuruvilla LC. Benign enlargement of sub-arachnoid spaces in infancy. J Pediatr Neurosci. 5/9/2014. 9:129-
31. [Medline]. [Full Text].
 Woodworth GF, McGirt MJ, Williams MA, Rigamonti D. Cerebrospinal fluid drainage and dynamics in the
diagnosis of normal pressure hydrocephalus. Neurosurgery. 2009 May. 64(5):919-25; discussion 925-
6. [Medline].
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