Hydrocephalus

Question 1

Definition

Answer 1

Excessive accumulation of CSF within the ventricular spaces of the brain.
In infants - Head enlarges
In infants and adults - Compression can damage brain tissue
Early detection and surgery - prognosis improves but remains guarded

Question 2

Causes/Incidence

Answer 2

May result from an obstruction in flow (noncommunicating hydrocephalus)
May result from faulty absorption (communicating)
Noncommunicating most frequently occurs between the 3rd and 4th ventricles at aquaduct of Sylvias
Communicating may result from surgery to repair a myelomeningocele, adhesions between meninges at base of brain or meningeal hemorrhage
Most common in neonates, but can occur in adults d/t disease
Effects 1/1000 people

Question 3

Signs and Symptoms - Infants

Answer 3

Rapid increase in head circumference
Widening and bulging of the fontanels
Distended scalp veins
Thin, shiny, fragile scalp skin
Underdeveloped neck muscles
If severe
Depressed orbit
Eyes displaced downward with prominent sclera
Sclera seen above iris is called “setting-sun sign”
High pitched, shrill cry, abnormal muscle tone of legs, irritability, anorexia and projectile vomiting commonly occur

Question 4

Signs and Symptoms - Older Children and Adults

Answer 4

Decreased level of consciousness
Ataxia
Incontinence
Loss of coordination
Impaired intellect

Question 5

Dx

Answer 5

Head circumference - Most important in infants
Skull films
Arteriography
CT
MRI (can discriminate between hydrocephalus and intracranial lesions and can also demonstrate Arnold-Chiari deformity)

Question 6

Tx

Answer 6

Surgical correction is the only treatment

Placement of a ventriculoperitoneal shunt or ventriculoatrial shunt (less common)