Congenital Hydrocephalus

Hydro = WaterCephalus =

Head

Water on the Brain

Excess accumulation of cerebrospinal fluid in the ventricles of the brain

TreatmentSurgical implantation

of fixed pressure or programmable shunts

Shunts follow pathways into the pleural cavity, the peritoneal cavity or the right atrium

ComplicationsMost Common

Shunt ObstructionLife Threatening Pre-Hospital Emergency Involves Increased ICP

Sepsis Inflammation and Infection on the Shunt

Pathwayincluding peritonitis and meningitis

1.Hypertension

2.Bradycardia

3.Irregular Respirations

Cushing’s Triad

Emergency Treatment of ICPAdequate Airway Breathing & OxygenationRapid Transport to Pediatric Facility

For Patients with Impending Herniation (e.g. – Cushing’s Triad)

Aggressive Hyperventilation, PaCO2 <30 mm Hg

Sepsis

Px with shunts presenting with sepsis can be

assumed to have meningitis.

Take isolation precautions

Treat for shock and/or dehydration as needed

Diagnosis is confirmed with a lumbar puncture

ConclusionEMS Treatment of Hydrocephalus related

emergencies need to be decisive and rapid

Immediate Transport to a Pediatric Facility with Neurosurgical Capabilities

Slide 1 – Picture courtesy of http://www.urmc.rochester.edu/neuroslides/slide165.html

Slide 2 – Picture courtesy of http://www.popovic.com.au/surgery_cranial_conditions.html

Slide 3 –Picture courtesy of http://www.lucinafoundation.org/assets/braindura.jpg

Slide 4 –Picture courtesy of http://www.lucinafoundation.org/assets/hydrocephalus.jpg

Slide 5 –Picture courtesy of http://www.cancerhelp.org.uk/cancer_images/brain-shunt.gif