Hydrocephalus PDF

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 10: Altered Neuronal Transmission Module 4: Clinical Models Dr. Romeo Batacan Jr. MPAT12001 Medical Pathophysiology Lec...

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 10: Altered Neuronal Transmission Module 4: Clinical Models Dr. Romeo Batacan Jr. MPAT12001 Medical Pathophysiology Lecture Series Copyright © 2017 Wolters Kluwer Health | Lippincott Williams & Wilkins  Hydrocephalus Clinical Treatment manifestations Diagnostic Pathophysiology criteria  Hydrocephalus Pathophysiology Imbalance of CSF fluid produced and reabsorped >>> Increased ventricular accumulation of CSF Ventricular enlargement Increased intracranial pressure (ICP) Long term consequence: motor disability (3/4 of children with hydrocephalus) Intellectual disability Classifications based on underlying cause Noncommunicating: CSF obstruction between ventricles Communicating: impaired absorption within subarachnoid space  Hydrocephalus Pathophysiology Causes Congenital (>50% of cases) Neural tube defect Spina bifida Altered cerebral aqueduct or choroid plexus Acquired hydrocephalus secondary to another disease Brain tumor Intraventricular hemorrhage Meningitis Traumatic injury Increased ICP is common consequence and may lead to Impaired perfusion leading to ischemia and cell death Atrophy caused by impaired circulation  Hydrocephalus Clinical Manifestations Clinical manifestations depends on Age of onset Underlying pathology/cause Severity of brain tissue compression Skull of newborn is less restrictive Increased head circumference (cardinal sign) Fontanels and unfused sutures of skull bones Marieb EN, Hoehn KN. Human Anatomy & Physiology. 9th ed. Boston, Pearson Education; 2013  Hydrocephalus Clinical Manifestations Age-dependent Infant Enlarged head with bulging fontanels Scalp vein distention Difficulty feeding High, shrill cry Older children/adults Impaired motor and cognitive function Incontinence Unresolved hydrocephalus may lead to impaired neurologic function and death due to increased ICP  Hydrocephalus Clinical Manifestations Signs and symptoms of increased intracranial pressure Increased blood pressure Promote perfusion to cerebral blood vessels Altered heart rate Initial tachycardia (increased) to increase blood flow >> followed by bradycardia (decreased) by the stimulation of baroreceptors Headache Stretching of vessel walls or meninges Vomiting Pressure on vomiting centre Decreased level of consciousness (LOC) Papilledema  Hydrocephalus Diagnostic Criteria Noninvasive: Head circumference measurement Transillumination: shining light against head to see fluid accumulations in the tissue Imaging studies CT, MRI for ventricle size X-ray to see skull bones separation  Hydrocephalus Treatment Establishment and maintenance of normal CSF volumes and pressure Surgical approach http://www.seattlechildrens.org/medical- conditions/brain-nervous-system-mental- conditions/hydrocephalus-treatment/ Ventriculoperitoneal shunt Ventriculoatrial shunt Catheter >> left lateral ventricle >> internal jugular vein >> right atrium Endoscopic third ventriculostomy Surgically open the floor of third ventricle Free-flowing release of CSF into basal cisterna Non-communicating hydrocephalus Marieb EN, Hoehn KN. Human Anatomy & Physiology. 9th ed. Boston, Pearson Education; 2013