2. •It is an excessive accumulation of CSF in the ventricles and
subarachnoid space of the brain.
• Hydrocephalus is commonly called “water on the brain.”
•It is a combination of the Greek word “hydro,” ---water and
“cephalus” --- head.
3. What is CSF?
• CSF looks like water, but it contains proteins, electrolytes, and nutrients
that help to keep brain healthy.
• The most important purpose of CSF is to cushion brain and spinal cord
against injury.
• Brain produces 20 ml of CSF per hour and 3-4 lit per day.
• It circulates through a network of tiny passageways in brain, and
ultimately into blood stream where it is absorbed by body.
4. Overview of CSF production
• The choroid plexuses are the
source of approximately 80% of
the CSF
• The blood vessels in the
subependymal regions, and pia
also contribute to the formation
of CSF
5. CSF circulation
Choroid plexus of lateral ventricles
Foramen Monro
Third ventricle
Aqueduct of sylvie
Fourth Ventricle
Foramen of Magendie and
Luschka
Subarachinoid space
6. CSF pressure
• Normal intracranial pressure (ICP) in
an adult is between 2-8 mmHg.
• Levels up to 16 mmHg are considered
normal
• ICP higher than 40 mmHg or lower BP
may combine to cause ischemic
damage
7. ETIOLOGY
• 1. Over production of CSF by choroid plexus
--- Tumor
--- Inflammation
• 2. Obstruction in the passage of CSF
--- Congenital atresia / narrow aqueduct of sylvius
--- Infections – meningitis, encephalitis
--- Tumor / haemorrhage / adhesion
• 3. Inadequate absorption of CSF
--- In extensive subarachinoid haemorrhage
8. CLASSIFICATIONS
I. a. Communicating / Non- Obstructive Hydrocephalus
No blockage between ventricular system,basal cisterns & spinal
arachinoid space.
It is due to --- failure in absorption of CSF. eg. Cavernous sinus thrombosis
--- over production of CSF. eg. choroid plexus papilloma,
pseudotumor of cerebri
b. Non- Communitcating / Obstructive Hydrocephalus
Blockage at any level of CSF pathway
It is due to --- obstructive lesion / inflammation
Obstruction ------- partial
------- intermittent
------- complete
9. • II. A. Congenital Hydrocephalus
Causes:
Intrauterine infection ( TORCH )
Congenital malformation – aqueduct stenosis
Dandy walker syndrome – Congenital septa /membrane block the forth
ventricle outlet
Arnold – chiari malformation – displacement of the brain stem and
cerebellum into upper cervical part of spine through foramen magnum
10. • b. Acquired Hydrocephalus
Causes
Inflammatory meningitis / encephalitis
Traumatic birth injury / head injury/ ICH
ICSOL- tuberculoma, abscess,glioma
Connective tissue disorder
11. PATHOPHYSIOLOGY
Non- communitating hydrocephalus communitating hydrocephalus
Blockage in between the ventricular & increased production / poor
Subarachnoid space absorption of CSF
Interference with the CSF circulation
16. MANAGEMENT
Pharmacological management
Acetazolamide – 50 mg/kg/day ( to decrease CSF production )
Oral glycerol & isosorbide
Antibiotics
Surgical management
Removal of obstruction in CSF flow
Ventriculostomy- destruction of portion of choroid plexus
Shunting of CSF from ventricle to another normal site in CSF pathway
Shunting of CSF from ventricle to an area outside CNS system
17. Types of extra cranial shunts
1. Ventriculoperitoneal shunt –
Common
Through a burr hole in the skull ventricular catheter is inserted into ant.
Portion of lateral ventricle.
A valve unit is tested & attached to the catheter.
An incision is made in the abdomen & through the rectus muscle in to the
peritoneum.
Here CSF is absorbed by tissues in the abdominal cavity
18. 2. Ventriculoatrial shunt
Catheter from lateral ventricle to RA of heart
Here CSF drains into circulating blood.
3. Ventriculoureter shunt
Here CSF drains through ureter & into the urinary bladder
Used in older children / if other two methods fails.
4. Ventriculopleural shunt
Here CSF drains into the pleural cavity.
19. NURSING MANAGEMENT
Preoperative
Assess for any signs of
increased ICP
Monitor head circumference
Assess vital signs frequently
Assess for any signs of
dehydration
Postoperative
Assess vital signs every 15 – 30
mints & monitor I/O chart.
Administer oxygen
Position-bed head elevation 15- 300
Assess for any signs of increased ICP
Assess for LOC & pupillary reactions
Assess patency of the shunt
Assess the nutritional status of the
child
Assess for any complications