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    Hydrocephaluss

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    Elvis
    Hydrocephalus is a condition where there is an excess of cerebrospinal fluid (CSF) in the brain, resulting in increased pressure inside the skull. It occurs when there is an imbalance between the production and absorption of CSF, causing it to accumulate in the ventricles of the brain. The main types are communicating and non-communicating hydrocephalus. Symptoms depend on age but may include increased head size, vomiting, irritability, and developmental delays. Diagnosis involves imaging tests and examination. Treatment often involves surgically implanting a shunt to drain CSF out of the brain.

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    Hydrocephaluss

    Uploaded by

    Elvis
    60 views32 pages
    Hydrocephalus is a condition where there is an excess of cerebrospinal fluid (CSF) in the brain, resulting in increased pressure inside the skull. It occurs when there is an imbalance between the production and absorption of CSF, causing it to accumulate in the ventricles of the brain. The main types are communicating and non-communicating hydrocephalus. Symptoms depend on age but may include increased head size, vomiting, irritability, and developmental delays. Diagnosis involves imaging tests and examination. Treatment often involves surgically implanting a shunt to drain CSF out of the brain.

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    Hydrocephalus is a condition where there is an excess of cerebrospinal fluid (CSF) in the brain, resulting in increased pressure inside the skull. It occurs when there is an imbalance between the production and absorption of CSF, causing it to accumulate in the ventricles of the brain. The main types are communicating and non-communicating hydrocephalus. Symptoms depend on age but may include increased head size, vomiting, irritability, and developmental delays. Diagnosis involves imaging tests and examination. Treatment often involves surgically implanting a shunt to drain CSF out of the brain.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    60 views32 pages

    Hydrocephaluss

    Uploaded by

    Elvis
    Hydrocephalus is a condition where there is an excess of cerebrospinal fluid (CSF) in the brain, resulting in increased pressure inside the skull. It occurs when there is an imbalance between the production and absorption of CSF, causing it to accumulate in the ventricles of the brain. The main types are communicating and non-communicating hydrocephalus. Symptoms depend on age but may include increased head size, vomiting, irritability, and developmental delays. Diagnosis involves imaging tests and examination. Treatment often involves surgically implanting a shunt to drain CSF out of the brain.

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    Hydrocephalus

    • The term hydrocephalus is derived


    from the Greek words "hydro"
    meaning water and "cephalus"
    meaning head.
    • Hydrocephalus results from an
    imbalance between production and
    absorption of CSF.

    • The balance between production and


    absorption of CSF is critically
    important.
    • When production is more than
    absorption, CSF accumulates within
    the ventricular system producing the
    dilation of the spaces in the brain
    called ventricles.

    • The ventricular system is made up of


    four ventricles connected by narrow
    pathways.
    • Normally, CSF flows through the
    ventricles, exits into cisterns (closed
    spaces that serve as reservoirs) at
    the base of the brain, bathes the
    surfaces of the brain and spinal cord,
    and then is absorbed into the
    bloodstream.
    • Ideally, the fluid is almost completely
    absorbed into the bloodstream as it
    circulates; however, there are
    circumstances which, when present,
    will prevent or disturb the production
    or absorption of CSF, or which will
    inhibit its normal flow. When this
    balance is disturbed, hydrocephalus
    is the result.
    Flow of CSF
    • lateral ventricles--> foramen of
    Monro third ventricle -->
    aqueduct of Sylvius --> fourth
    ventricle --> foramina of
    Magendie and Luschka -->
    subarachnoid space over brain
    and spinal cord --> reabsorption
    into venous sinus blood via
    arachnoid granulations.
    Incidence
    • Occurs in 3 - 4 cases in every 1000
    births.
    • Hydrocephalus may be

    Communicating
    Non – communicating ( obstructive )
    Communicating hydrocephalus
    • There is no blockage between the
    ventricular system, the basal cisterns
    and the spinal subarachnoid space.

    • Failure in the absorption system-


    unknown cause
    • Excessive production of CSF- tumor
    or unknown cause
    Obstructive or
    Non-Communicating hydrocephalus
    • The block is at any level in the
    ventricular system (source of
    production and area of its
    reabsorption), commonly at the level
    of the aqueduct or foramina of
    Luschka and Magendie.
    • There are two other forms of
    hydrocephalus which do not fit
    distinctly into the categories
    mentioned above and primarily
    affect adults:
    1. Hydrocephalus ex-vacuo and
    2. Normal pressure hydrocephalus.
    • Hydrocephalus ex-vacuo:
    Hydrocephalus ex-vacuo occurs
    when there is damage to the brain
    caused by stroke or traumatic injury.
    In these cases, there may be actual
    shrinkage (atrophy or wasting) of
    brain tissue. In cerebral atrophy
    ventricles are dilated but pressure is
    not raised .
    • Normal pressure hydrocephalus.
    Normal pressure hydrocephalus
    commonly occurs in the elderly and
    is characterized by memory loss,
    dementia, gait disorder, urinary
    incontinence, and a general slowing
    of activity.
    Causes
    Hydrocephalus can be congenital or
    acquired.
    • Congenital hydrocephalous:

     Intrauterine infections ( rubella,


    cytomegalovirus, toxoplasmosis),
     Intracranial & intraventricular bleed.
     Midline tumors
     Congenital malformations
    • Acquired hydrocephalous:

    Tuberculosis
    Chronic and pyogenic meningitis
    Intraventricular hemorrhage
    Posterior fossa tumors:
    medulloblastoma, astrocytoma,
    ependymoma
    Arteriovenous malformation
    Intracranial hemorrhage
    Ruptured aneurysm
    Pathophysiology
    • The ventricles become greatly
    distended

    • The increased ventricular pressure


    results in thinning of the cerebral
    cortex and cranial bones especially
    frontal, parietal and temporal areas.
    • The floor of the third ventricle commonly
    bulges downward, compress the optic
    nerves

    • The basal ganglia, brain stem and


    cerebellum remain relatively normal but
    compressed

    • The choroid plexus is usually atrophied to


    some degree.
    Clinical manifestations
    • Symptoms of hydrocephalus vary with
    age, disease progression, and individual
    differences in tolerance to CSF. For
    example, an infant's ability to tolerate CSF
    pressure differs from an adult's. The infant
    skull can expand to accommodate the
    buildup of CSF because the sutures (the
    fibrous joints that connect the bones of
    the skull) have not yet closed.
    In infancy
    • The most obvious indication of
    hydrocephalus is often the rapid
    increase in head circumference or an
    unusually large head size.

    • Delayed closure of the anterior


    fontanelle, tense and elevated.
    • Spasticity of muscles of extremities
    • Later signs: bossing of forehead,
    scalp appears shiny with prominent
    scalp veins, eyebrows and eyelids
    drawn upward, sunset eyes in
    infants, difficulty holding head,
    strabismus, nystagmus, optic
    atrophy, physical and mental
    development lag
    • Older children
    Older children have closed sutures and
    present with signs of IICP.
    Signs of increased ICP
    • Vomiting, sleepiness, restlessness,
    irritability, high pitched shrill cry ( infant),
    tensed bulging fontanelle ( infant), rapid
    increase in head circumference ( infant),

    • Changes in vital signs ( increased systolic


    pressure, decreased pulse, decreased and
    irregular respiration, increased
    temperature), pupillary changes,
    papilledema, lethargy and stupor, coma,
    seizures.
    • Older children may also experience;
    headache, especially on awakening,
    lethargy, fatigue, apathy, problems with
    balance, poor coordination, gait
    disturbance, urinary incontinence,
    personality changes, separation of cranial
    sutures ( upto 10 yrs ) visual changes
    ( double vision )downward deviation of the
    eyes (also called "sunsetting").
    Diagnostic evaluation
    • Physical examination infant’s head
    transilluminates, Macewen’s sign
    ( cracked pot sound on percussion )
    • Ophthalmoscopy
    • CT scan
    • Skull x-ray
    • Ventriculography ( rare )
    Treatment
    • Surgical
    Direct operation on the lesion causing obstruction
    such as tumor

    Intracranial shunts to divert fluid in


    noncommunicating hydrocephalus from
    ventricular system to the subarachnoid space

    Extracranial shunts to divert fluid from ventricular


    system to an extracranial compartment
    frequently peritoneum or right atrium
    Complications
    • Complications may include mechanical
    failure, infections, obstructions, and the
    need to lengthen or replace the catheter.

    • Generally, shunt systems require


    monitoring and regular medical follow up.
    When complications do occur and due to
    growth of child, usually the shunt system
    will require some type of revision.
    • Child with V-A shunt may experience
    endocardial contusion, clotting,
    leading to bacterial endocarditis,
    bacteremia, thromboembolism.
    Nursing diagnosis
    • Altered cerebral tissue perfusion r/t
    IICP
    • Altered nutrition ( less ) r/t reduced
    oral intake and vomiting
    • Risk of impaired skin integrity r/t
    alteration in level of conciousness
    and enlarged head
    • Anxiety r/t surgery
    • Risk for fluid volume deficit r/t CSF
    drainage, decreased intake
    postoperatively
    • Risk for injury r/t malfunctioning
    shunt, infection
    • Ineffective family coping r/t
    diagnosis and surgery

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