5.7 Hydrocephalus and Spina Bifida

Question 1

Hydrocephalus

Answer 1

• Abnormal fluid accumulation in the ventricles of the brain
• Primarily caused by obstruction of CSF pathway causing increased pressure in the skull.

CAUSES
- Myelomeningocele
- Hemorrhage (blood causes blockage)
- Meningitis (scarring restricts flow)
- Tumor (compression on ventricles)

SYMPTOMS
- Head girth growing at abnormal rate
- Bulging fontanels
- Thinning of skull bones
- Dilation of scalp veins
- Fontanel enlargement (Bossing)
- Sunsetting eyes
- Neurocry

DIAGNOSIS
- Ultrasound/CT/MRI

TREATMENT
- Shunts to drain fluid (most effective way)
- Surgical procedure where flexible tube is put in to drain the CSF.
- VP Shunt - Ventroperitoneal shunt
- VA Shunt - Aorta shunt

SYMPTOMS OF SHUNT MALFUNCTION
- Enlargement of patients head (again)
- Tense fontanels
- Scalp veins
- Swelling/redness along the shunt
- Fever/Vomiting/Irritability/Sunset Eyes

• Educate parents on signs of infection (increased pulse, fever, high pitched cries, pus coming out of sutures)
• INFECTION IS A MEDICAL EMERGENCY

Question 2

Neural Tube Defects

Answer 2

• Failure of neural tubes to close around the spine/spinal cord (happens during fetal development)

Question 3

Spina Bifida

Answer 3

2 Types

Meningocele
- External sack encases meninges and spinal fluid but does not contain neural elements
- Positive Transillumination (can shine light through)

Myelomeningocele
- External sack that contains meninges, spinal fluid and neural tissue
- If the sack ruptures then there is open access to spinal cord, meninges and nerves.

Question 4

Spina Bifida (cont)

Answer 4

• Neural tubes failed to close in utero during the first 28 days
• Normally occurs in lumbar area of spine

SYMPTOMS
- Loss of bower/bladder function
- Paralysis of the legs
- Dislocation of hips
- Clubbed feet

• Commonly associated with hydrocephalus

DIAGNOSIS
- Prenatal ultrasound or CT/MRI

Prevention
- Educate importance of folic acid
(Leafy greens, asparagus, broccoli, oranges, papaya, avocado, seeds/nuts, cauliflower)

Question 5

Nursing Care Spina Bifida

Answer 5

• Protect the sack and maintain its integrity until surgery can be preformed to enclose
• Sleep position will be prone with no diapers or clothing over the sack
• Hips will be abducted (like a frog) and elevated with towel/sponge
• Keep the sack moist and warm (with gauze)