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2. GREEK – HYDRO {WATER} & KEPHALE {HEAD}
DEFINITION :
ABNORMAL EXCESSIVE ACCUMULATION OF CSF WITHIN
VENTRICLES/CAVITIES IN BRAIN
ABNORMAL DILATATION OF THE SPACES
POTENTIALLY HARMFUL PRESSURE ON THE TISSUE OF
THE BRAIN
9. CLASSIFICATION :
1)COMMUNICATING TYPE :
EXTERNAL / NON OBSTRUCTIVE TYPE
OBSTRUCTION OUTSIDE THE VENTRICULAR SYSTEM
(IN BASAL CISTERNS/ARACHNOID VILLI)
RESORPTION IMPAIRED DUE TO SCARRING/ FIBROSIS
10. 2) NON COMMUNICATING TYPE :
BLOCK WITHIN THE VENTRICULAR SYSTEM AT VARIOUS SITES
MOST COMMON IN THIRD VENTRICLE AND AQUEDUCT
VENTRICLES – DILATED
EPENDYMA OF VENTRICLES MAY BE DISRUPTED
CORTICAL ATROPHY (MORE ICP)
11. NORMAL PRESSURE HYDROCEPHALUS :
Post traumatic, post meningitic , SAH , deficieny of arachnoid granulations.
Intermittent raise of ICP
Enlarged ventricles ,normal CSF pressure ,cortical atrophy ,absence of papilledema.
Hakim triad - gait apraxia, incontinence, and dementia.
Headache is NOT a typical symptom in NPH, no sensory loss.
Magnetic gait, personality changes,
DTR increased, BABINSKI positive, release reflexes.
14. ARRESTED HYDROCEPHALUS /
COMPENSATED HYDROCEPHALUS
no progression or deleterious sequelae requiring CSF shunting
- Near normal ventricular size, head growth curve
- Continued psychomotor development
15. SPECIAL FORMS :
“HYDROCEPHALUS EX-VACUO”
dilatation of the ventricles
CSF pressure is normal
Shrinkage of brain substance
Damage to the brain
Stroke or other form of injury
Chronic neuro degeneration
16. “EXTERNAL HYDROCEPHALUS /
BENIGN ENLARGEMENT OF THE EXTRA-AXIAL SPACES”
Excessive CSF-subarachnoid spaces
Ventricles -not enlarged significantly
Infant and early children.
Associated with familial macrocephaly
resolution within 1 year
ARRESTED HYDROCEPHALUS /
COMPENSATED HYDROCEPHALUS
no progression requiring CSF shunting
- Near normal ventricular size, head growth curve
Continued psychomotor development
18. CT/MRI FINDINGS:
Temporal Horns > 2mm
EVANS ratio
Upward bowing of corpus callosum
Erosion of sella turcica
Ballooning of the Frontal Horns &
3rd Ventricles (Mickey Mouse sign)
19. TREATMENT :
MEDICAL:
DIURETICS:
Acetazolamide (Diamox) 50mg /kg/day
Furosemide (Lasix) 1mg/kg/day
Watch for electrolyte imbalance and
acetazolamide side effects:
Lethargy - tachypnea
diarrhoea - paresthesias
Perform weekly CT scan.
maintain therapy for a 6 month trial, then taper
dosage over 2-4 weeks
20. SURGICAL :
Choroid Plexectomy
Choroid plexus coagulation
3rd Ventriculostomy
Endoscopic fenestration of floor of third
ventricle
Cerebral aqueductoplasty
TAPPING: LP performed only in
communicating hydrocephalus.
Surgical correction of the tumour/cysts
Shunts
22. COMPLICATIONS OF SHUNTING:
INFECTIONS
STAPH. EPIDERMIS AND STAPH. AUREUS.
OBSTRUCTION OF THE CATHETER
INTRACEREBRAL /SUBDURAL HEMORRHAGE
OVER SHUNTING (VP SHUNTS)
MISPLACEMENT
SEIZURES
CSF ASCITES
23. FOLLOW UP:
HC MONITORING
SIGNS OF INFECTION/BLOCK
ANTIBIOTIC PROPHYLAXIS
RE-EVALUATION
PROGNOSIS:
depends on primary cause
Large IVH- permanent hydrocephalus
NPH- responds to shunt
gait and incontinence respond to shunting
but dementia responds less frequently.