HYDROCEPHALUS

Sam Lazuardi
HYDROCEPHALUS (H) 1
(National Institute of Neurological Disorders and Stroke NIH)
Is the buildup of too much csf in the brain.
Normally, csf cushions the brain, when it is too
much, it puts harmful pressure on the brain.
2 kinds of H: 1.Congenital H is present at birth,
causes incl. genetic problems & problems with
how the fetus develops. The main sign is an
unusual large head


HYDROCEPHALUS (H) - 2
2.Acquired H can occur at any age.
Causes incl. head injuries, strokes, infections,
tumor & bleeding in the brain.
Symptoms : hache, vomiting & nausea, blur-ry
vision, balance problems, bladder control
problems, thinking & memory problems
H can permanently damage the brain with
physical & mental problems
HYDROCEPHALUS (H) - 3
If untreated, it is usually fatal
With treatment, can lead normal lives with
some limitations
Treatment involves surgery to insert a shunt
Medicine & rehabilitation th/ can also help
SIGNS AND SYMPTOMS OF H VARY
GENERALLY BY AGE ONSET -1
Infants :
A rapid increase in size of the head
A bulging or tense fontanel on top of the head
Vomiting, irritability, poor feeding
Sleepiness
Seizures
Eyes fixed downward (sun-setting of the eyes)
Deficits in muscle tone & strength
SIGNS AND SYMPTOMS OF H VARY
GENERALLY BY AGE ONSET -2
Toddlers & older children :
Abnormal head enlargement
Hache, nausea, vomiting, fever, irritability
Problems with previously acquired skills
(walking or talking, decline in school
performance)
Blurred double vision, unstable balance
Seizures, sleepiness, poor appetite
SIGNS AND SYMPTOMS OF H VARY
GENERALLY BY AGE ONSET -3
Young & middle aged adults :
Hache. Impaired vision
Difficulty in remaining awake or waking up
Loss of coordination or balance
Loss of bladder control frequent urge to
urinate
Decline in memory, concentration & other
thinking skills that may affect job performance
SIGNS AND SYMPTOMS OF H VARY
GENERALLY BY AGE ONSET -4
Older adults (60 yrs and older):
Loss of bladder control, frequent urge to
urinate
Memory loss, poor coordination balance
Difficulty walking, shuffling gait
Progressive loss of other thinking reasoning
skills
Slower than normal movements in general

SEEK EMERGENCY MED CARE FOR
INFANTS - TODDLERS
A high pitched cry
Problems with sucking or feeding
Unexplained recurrent vomiting
An unwillingness to bend or move the neck or
head
Breathing difficulties
Seizures
CEREBROSPINAL FLUID (CSF) - 1
Is produced by tissues lining the ventricles of
the brain & flows into spaces around the brain
& spinal cord, its absorbed by blood vessels in
tissues near the base of the brain.
CSF function :
Allowing the heavy brain to float within the
skull
Cushioning the brain to prevent injury
CEREBROSPINAL FLUID (CSF) - 2
Removing waste products of brains
metabolism
Flowing back & forth between brain cavity &
spinal column to maintain a constant pressure
within the brain , compensating for changes in
blood pressure in the brain

EXCESS CSF ARE CAUSED BY :
Partial obstruction of normal flow of CSF
most common
Poor absorption related to inflammation of
brain tissues from disease or injury less
common
Overproduction of CSF - rarely

RISK FACTORS :
Newborn congenital H :
Abnormal development of CNS that can obstruct
the flow
Bleeding within ventricles (premature birth)
Infection (rubella, syphilis)
Acquired H (any age group) :
Lesions or tumors of the brain or spinal cord
Infections fo CNS, bleeding (stroke, head injury)
COMPLICATIONS OF H
Congenital H -> intellectual, developmental &
physical disabilities
Acquired H -> decline in memory or other
thinking skills & have poorer recoveries &
persistent symptoms after the treatment
MONITOR THE CHILD DEVELOPMENT
Head size & rate of head growth
Growth
Muscle tone & strength
Coordination
Posture
Age-appropriate motor skills
Sensory abilities- vision, hearing and touch
NEUROLOGICAL EXAM
Reflexes
Muscle strength & tone
Sense of touch
Vision and eye movement
Hearing
Coordination & balance
Mental status & mood
BRAIN IMAGING
Ultrasound (USG) : simple, low risk initial
assessment for infant over the fontanel
routine prenatal exam to detect H prenatally
CT-scan : only for emergency & require mild
sedation to keep the infant lying still 20 min
MRI : the test is noisy & requires lying still
mild sedation 1 hour exam
TREATMENT AND DRUGS - 1
1.Shunt : surgical insertion of a drainage syst,
a shunt consist of a long, flexible tube with a
valve that keeps fluid from the brain flowing in
the right direction and at the proper rate
One end of the tubing is placed in one of the
brains ventricle, the tubing is then tunneled
under the skin to the abdomen or chamber in
the heart, where the excess CSF can be easily
absorbed
TREATMENT AND DRUGS - 2
2.Ventriculostomy : is a surgical procedure,
where the surgeon uses a small video camera
to have direct vision inside the brain and
makes a hole in the bottom of one of the
ventricles or between the ventricles to enable
CSF to flow out of the brain
COMPLICATIONS OF SURGERY - 1
Both procedures can result in complications
Shunt systems can stop draining CSF or poorly
Regulated drainage because fo mechanical
malfunctions, blockage or infections
The passage created during a ventriculostomy
can suddenly close
Signs and symptoms may include :
COMPLICATIONS OF SURGERY - 2
Fever. hache, drowsiness
Irritability, nausea & vomiting
Vision problems
Redness, pain or tenderness of the skin along
the path of the shunt
Abd pain when the shunt valve is in the abd
Recurrence of any of the initial H symptoms
PREVENTION OF HYDROCEPHALUS
1.Regular prenatal care
2.Protect against infectious diseases : follow
the recommended vaccination and screening
schedules for your age and sex
3.Prevent head injury :
Use appropriate safety equipment for children
Wear a seat belt in a motor vehicle
NORMAL PRESSURE HYDROCEPHALUS
NPH- 1
Is an abn increase of CSF in the brains ventri-
cles, as the normal flow is blocked in some
way & causes the ventricle to enlarge, putting
pressure on the brain
Most common in the elderly, caused by sub-
arachnoid hemorrh, head trauma, infection,
tumor, complications of surgery or unknown
cause.
NORMAL PRESSURE HYDROCEPHALUS
NPH- 2
Symptoms : progressive mental impairment
and dementia, walking problems, impaired
bladder control leading to urinary frequency
& incontinence
Treatment : shunt operation
Early diagnosis and treatment improves the
chance of a good recovery