Hydrocephalus.pdf

Hydrocephalus DR EKPENE OUTLINE INTRODUCTION EMBRYOLOGY EPIDEMIOLOGY AETIOLOGY DIAGNOSIS TREATMENT PREVENTION CONCLUSION INTRODUCTION Definition - Build up of CSF within the ventricles resulting from excessive production, obstruction to flow or impaired reabsorption, usually...

Hydrocephalus DR EKPENE OUTLINE INTRODUCTION EMBRYOLOGY EPIDEMIOLOGY AETIOLOGY DIAGNOSIS TREATMENT PREVENTION CONCLUSION INTRODUCTION Definition - Build up of CSF within the ventricles resulting from excessive production, obstruction to flow or impaired reabsorption, usually associated with clinical sequelae from an increase in ICP. -’ Hydro‘ water - ‘kefala’ Head EPIDEMIOLOGY Nigeria – ? 34/100,000 Czech republic Incidence – 6.35/10,000 live born infants M:F = equal except X-linked type (Bickers-Adams syndrome) CSF physiology – ventricular system CLASSIFICATION Communicating (non-obstructive) vs non-communicating (Obstructive) Hydocephalus ex vacuo Acute vs chronic Primary vs Secondary AETIOLOGY Congenital - Intrauterine infections - TORCHES - Intrauterine trauma - Congenital malformation – DWM, Aqueductal stenosis, Arnold Chiari malformation, arachnoid cyst, vein of Galen malformation etc Acquired - Trauma with IVH, SAH or posterior fossa ICH - Haemorrhagic CVD with SAH, IVH - CNS infection - Tumour CLINICAL MANIFESTATION History Infants Older children Adults Examination Infants Older children/adults CLINICAL FEATURES DEPENDS ON: Patient's age Cause Location of obstruction Duration Rapidity of onset CLINICAL FEATURE Symptoms in infants include the following Poor feeding Irritability Reduced activity Vomiting CLINICAL FEATURE Symptoms in children include the following: Slowing of mental capacity Headaches Neck pain suggesting tonsillar herniation Vomiting Blurred vision Double vision Stunted growth and sexual maturation from third ventricle dilatation: Difficulty in walking secondary to spasticity Drowsiness CLINICAL FEATURE NORMAL PRESSURE HYDROCEPHALUS Gait abnormality Dementia - Memory impairment Urinary incontinence CLINICAL FEATURES - PHYSICAL EXAM. Head enlargement Dysjunction of sutures Dilated scalp veins The scalp is thin and shiny with easily visible veins. Tense fontanelle Setting-sun sign: In infants Increased limb tone Physical findings in children include the following: Papilledema: Failure of upward gaze. Macewen sign Unsteady gait Large head Unilateral or bilateral sixth nerve palsy is secondary to increased ICP PHYSICAL EXAM. Physical findings in adults include the following: Papilledema/optic atrophy Failure of upward gaze and of accommodation indicates pressure on the tectal plate. Unsteady gait is related to truncal and limb ataxia. Spasticity in legs also causes gait difficulty. Large head (macrocephaly): The head may have been large since childhood. Unilateral or bilateral sixth nerve palsy is secondary to increased ICP. Children with ventricular-peritoneal shunts may be more likely to have congenital esotropia. INVESTIGATION Prenatal USG/MRI Transfontanele USG Skull x-ray Cranial CT scan Brain MRI - Cine MRI - Diffusion Tensor imaging TREATMENT Nonsurgical Acetazolamide, furosemide, ?hyaluronidase, ?mannitol etc, intermittent CSF tapping Surgical Endoscopic Third Ventriculostomy Ventriculoperitoneal shunting Ventriculopleural External ventricular drainage Tokildsen COMPLICATIONS OF SURGERY Shunt infection Shunt malfunction Shunt migration ICH Neurologic deficit Bowel perforation