14 Questions
What is hydrocephalus defined as?
Abnormal accumulation of CSF within the head
What type of hydrocephalus is caused by obstruction within the ventricular system?
Non-communicating hydrocephalus
What is the name of the condition where there is cystic dilatation of the 4th ventricle with atrophy of the cerebellum?
Dandy Walker syndrome
What is a common cause of communicating hydrocephalus?
Subarachnoid hemorrhage
What is a characteristic physical examination finding in hydrocephalus?
Wide open and tense anterior fontanel
What is Macewen's sign?
A cracked pot percussion note of the skull
What is a common neurological finding in hydrocephalus?
Brisk tendon reflexes
What is a characteristic eye finding in hydrocephalus?
Sunset appearance
What is a common feature of mental retardation in older children?
Partially closed sutures
What is the primary purpose of a VP shunt in the treatment of mental retardation?
To allow CSF to flow from the lateral ventricle to the peritoneal cavity
Which of the following is a differential diagnosis of mental retardation?
Subdural hematoma
What is the purpose of transillumination of the skull in the diagnosis of mental retardation?
To determine if the skull is positive for mental retardation
What is a common symptom of mental retardation in both age groups?
Lethargy
What medication is used to reduce the rate of CSF production in mental retardation?
All of the above
Study Notes
Definition and Physiology
- Hydrocephalus is an abnormal accumulation of CSF within the head due to impaired circulation and absorption, or rarely from increased production by choroid plexus papilloma.
- Obstructive or non-communicating hydrocephalus occurs when there is an obstruction within the ventricular system.
- Non-obstructive or communicating hydrocephalus occurs when there is obliteration of subarachnoid cisterns or malfunction of arachnoid villi.
Causes of Obstructive or Non-Communicating Hydrocephalus
- Congenital causes:
- Aqueductal stenosis
- Malformation of vein of Galen
- Dandy-Walker syndrome: cystic dilatation of the 4th ventricle with atrophy of the cerebellum
- Chiari malformation type II: elongation of the 4th ventricle with kinking of the brain stem
- Acquired causes:
- Neonatal meningitis or intracranial hemorrhage
- Lesions of the posterior fossa (e.g., tumor, abscess)
Causes of Non-Obstructive or Communicating Hydrocephalus
- Subarachnoid hemorrhage, especially in prematures
- Meningitis (pneumococcal and tuberculous)
- Intrauterine intracranial infections (e.g., toxoplasmosis, CMV)
- Leukemic infiltration
Clinical Manifestations
- Before closure of fontanels: 50% are asymptomatic
- Progressive increase in head size
- Separation of sutures
- Fontanels are widely open, tense, and persistent
- Dilated scalp veins
- Stretched scalp skin
- Macewen sign: cracked pot percussion note of the skull due to separation of sutures
- Audible bruit in cases of malformation of vein of Galen
- Eyes: sun set appearance and progressive optic nerve damage
- Pyramidal tract lesion with brisk tendon reflex, spasticity, clonus, and Babinski sign
- Mental retardation occurs late when extensive cerebral cortex atrophy
Diagnosis
- History: familial cases in aqueductal stenosis, prematurity, meningitis, or encephalitis
- Examination: head circumference recorded and compared with previous measurements
- Fundus examination: may show papilledema or optic atrophy
- Transillmination of the skull: is positive
- Plain X-ray of the skull: large head, separated sutures, wide sella turcica
- Serology for TORCH
- CT scan and MRI: for specific cause as tumors
Differential Diagnosis
- Megaloencephaly: large-sized head due to increased glial tissue
- Subdural hematoma: chronic
- CNS degenerative and metabolic brain disorders
- Brain tumors
Treatment
- Depends largely on the cause
- Medical: to reduce rate of CSF production using acetazolamide or furosemide
- Extracranial shunt: VP shunt allows CSF to flow from lateral ventricle to the peritoneal cavity.
This quiz covers the diagnosis of hydrocephalus in children, including signs and symptoms, medical history, and examination methods. It discusses the differences in presentation between younger and older children.
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