hidrocephalus
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Transcript of hidrocephalus
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Functional Classification
1. Obstructive HCP
Granulatio arachnoidea
2. Communicating HCP
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ETIOLOGIES
Congenital
• Chiari type 1• Chiari type 2• Aqueductal stenosis• Dandy-Walker malformation
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Acquired
• Post Infections : meningitis• Post hemorrhagic : SAH, IVH• Secondary to masses
• Non neoplastic : vasc malformation• Neoplastic, especially tumors around
aquaductus Medulloblastoma• Post op cerebral tumor removal
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Arrested hydrocephalus• Compensated HCP• No progression or deleterious sequelae
due to HCP that would require shunt• Crit : near N ventricular size
N head growth curvecont’ psychomotor development
Family education : seek medical help if they develop symptoms of intracranial hypertension (headache, vomiting, ataxia, visual symptoms)
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Diagnosis
• TH > 2mm• FH/ID > 0,5• Mickey mouse• Transependymal absorption• Evan’s ratio FH/BPD > 30% (N : 23-
27%)• Upward bowing corpus callosum
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Signs and Symptoms
• Craniofacial disproportion• Irritability, poor head control• Fontanelle full and bulging• Enlargement scalp veins• Cracked pot sound (Macewen’s sign)• Abducens palsy• Sun set phenomen (upward gaze palsy)• Irregular respiration with apneic spells• Splaying of cranial suture (Xray)
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DIFFERENTIAL DIAGNOSIS
•HCP ex vacuo(Atrophy cerebri)
•Hydrancephaly
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Hydrocephalus ex vacuo
- enlargement of ventricles
- cerebral atrophy- usually aging- not true
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Hydrancephaly
• Post neurulation defect• Absence of brain tissue supplied by ICA
but intack by PCA• Filled with CSF• HCP : cortical mantel +• In shunting : control head size, no re-
expansion• Kx : hyperirritable, no social smiling, retain
primitive reflexes, seizure• EEG : no cortical activity
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TREATMENT
• Medical• Spinal taps• Surgical
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Medical therapy
Diuretics
As adjunct to definitive treatment or as a temporizing measure
Acetazolamide25mg/kg/day (PO,TID)Increase until 100mg/kg/day
Furosemide1mg/kg/day(PO,TID)
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Spinal taps
Ventricular or Lumbar taps
• In IVH serial taps until resorption resumes
• When resorption does not resume ( prot > 100mg/dl), usually need shunt
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Complications of shunts
• Obstruction• Disconnection at a junction• Break• Infection• Hardware erosion through skin• Silicone allergy• Conduit for extraneural metastases
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VP shunt complications• Inguinal hernia• Need tom lengthen with growth• Obstruction of peritoneal cath• Peritonitis• Hydrocele• Ascites• Tip migration in to scrotum• Perforation of viscus• Intestinal obstruction• Volvulus• Overshunting
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Complications VA shunt
• Repeated lengthening • High risk of infection• Septicemia• Retrograde flow of blood in to
ventricles• Embolus• Vasc complications :
thrombophlebitis, perforation