Hydrocephalis

Question 1

what are the causes of hydrocephalus

Answer 1

1-over production of CSF
2-Increased resistance to CSF
3-Reduced Absorption of CSF flow
4-Increased pressure in dural venous sinuses

Question 2

what are the symptoms of hydrocephalus ?

Answer 2

In the subarachnoid space :
1) CSF accumulates and pushes on the optic nerve
- Excess fluid is absorbed by optic nerve routes
- Enlargment of optic nerve sheaths = Papilledema
2) Dilation of lateral ventricels
3) Enlargement of the 3rd ventricle
- Presses down on the pituitary gland
- Pituitary dysfuntion
Compression of midbrain , raised ICP and cerebral herniation

Other symptoms :

• slowing mental capacity
• Headache
• Neck pain
• Vomiting
• Blurred vision
• Double vision due to 6th nerve abducens palsy
• Drowsiness
• Limb spasticity

Question 3

What are the 4 different types of hydrocephalus?

Answer 3

1) Non communicating Hydrocephalus
2) Communicating Hydrocephalus
3) Normal pressure hydrocephalus
4) Congental hydrocephalus

Question 4

when does Normal pressure Hydrocephalus occur (NPH)?

Answer 4

1) Rare- occurs in elderly people
2) large ventricles , but no papilledema (optic nerve swelling) , increased ICP at night sometimes

3 main symptoms :
Incontinence 
Gait Apraxia 
Dementia 
(IGD)

Question 5

Comminicating hydrocephalus

Answer 5

1- normal Flow between the ventricles and subarachnoid space
it is due to :
- defective absorption of CSF
- Overproduction of CSF(rare)

causes can be :
- intracranial haemorrhage
-Meningitits
-Brain tumour
All lead to damage to the arachnoid granulations where CSF is absorbed
- Venous thrombosis = venous draining insufficiency

this all lead to increases CSF in subarachnoid space causing progressive degrading (atrophy ) of the Brian tissue

Question 6

What is non communicating hydrocephalus ?

Answer 6

CSF flow obstruction in the ventricular system ie : lesions which disrupt the ventricular anatomy , accumaltion of CSF and Enlargement of the ventricles

Question 7

What is congenital hydrocephalus

Answer 7

dilation of ventricles in fetal or infancy periods
causes:
- obstruction of cerebral aqueduct
-premature birth leading to bleeding of the Brain

Question 8

Sign to look for in diagnosis of hydrocephalus

Answer 8

• head enlargement
• disjunction of sutures
• DIlation of scalp veins
• Tense frontenelle (buldging )
• increased spasticity of the lower limbs ( muscle tightness )
• Setting sun sign of the eyes ( eyes look down )
• retracted upper eyelids

Normal pressure Hydrocephalus can present as :
- increased reflexes and positive babinski sign
-Vascualr Parkinsonism
(slow movement, tremor ,difficulty in walking )
-Normal muscle strength with no sensory loss

Question 9

Imaging studies for hydrocephalus

Answer 9

• CT = size fo ventricle
• MRI to look for periaqueductal ad cerebellar tumours ,Chiari malformation
• Ultrasound in infants
• skull radiography

Question 10

Management of hydrocephalus

Answer 10

1) Ventriculoperitoneal shunt
2) Ventriculoatrial shunt
3) Lumboperitoneal shunt (communicating hydrocephalus )

Question 11

What do we do in rapid onset Hydrocephalus ?

Answer 11

• Ventricular tap
• Open Ventricular drainage
• VP/VA shunt