-what is hydrocephalus -introduction of hydrocephalus -embryonic development -normal CSF circulation -flow of CSF -congenital hydrocephalus -acquired hydrocephalus -types of hydrocephalus -communicating hydrocephalus -non communicating hydrocephalus -symptoms -Crack pot sign -Macewen Sunset sign -testing and diagnosis of hydrocephalus -medical management of hydrocephalus -surgical management of hydrocephalus -physiotherapy management of hydrocephalus -recent advance in hydrocephalus -hydrocephalus physiotherapy

1. HYDROCEPHALUS
Presented by-Shadab Khan
MPT 2
Paediatric Physiotherapy
Department

2. CONTENT
• INTRODUCTION
• PREVALANCE
• CAUSES
• TYPES
• SYMPTOMS
• DIAGNOSIS
• TESTING
• MEDICAL MANEGMENT
• SURGICAL MANEGMENT
• COMPLICATION
• PHYSIOTHERPY MANEGMENT
• RESENT ADVANCE
• REFRENCES

3. INTRODUCTION
Hydrocephalus is excessive accumulation or
production of cerebrospinal fluid in the ventricle of
brain or blockage of normal flow of CSF between
the ventricle and spinal canal and also due to
inadequate absorption. If it is left untreated ,
increase in pressure on the skull and brain which
can damage the structures of the brain.

4. PREVALENCE
• There is 6000 cases of hydrocephalus born in every year in india,
worldwide incidence of pediatric hydrocephalus at nearly 400,000 cases,
across all racial and ethnic group .
• https://www.researchgate.net/publication/324814979_Global_hydrocephalus_epidemiology_and_incidence_Systematic_review_a
nd_meta-analysis

5. • Cerebrospinal fluid (CSF)-
is a liquid secreted by the
choroid plexus found with
in the ventricles of the brain
by ultrafiltration and active
secretion . It surrounds the
brain and spinal cord,
acting as a protective
cushion against injury.

6. • CSF is produced at a rate of 0.33 ml/min, which is approximately 500
ml/day. The total volume of CSF varies with age and in the adults is
100–150 ml in ventricles
• On the basis, the upper limit values for CSF are 108 mg/dL for infants
≤28 days and 77 mg/dL for infants 1 to 2 months of age.

7. CSF CIRCULATION

8. Lateral ventricle
Foramen of Monro 3rd ventricle
4th ventricle aqueduct of sylvius
Foramen of Magendie and Luschka
Subarachnoid space of brain and spinal cord
Reabsorption into venous circulation

9. CAUSES
1. Congenital hydrocephalus :
• Congenital malformation :
• Aqueduct stenosis
• Neural tube defect
• Dandy walker syndrome
• Arnold Chiari syndrome
• Intrauterine infection – Rubella,
Cytomegalovirus, Toxoplasmosis

10. 2. Acquired hydrocephalus : develops after birth as a result of
neurological conditions such as:
• Head trauma
• Brain tumor
• Meningitis
• Post intraventricular haemorrhage or Intracranial haemorrhage

11. TYPES
• Hydrocephalus can be classified as :
• communicating hydrocephalus
• non communicating hydrocephalus

12. COMMUNICATING HYDROCEPHALUS
• This type of hydrocephalus occurs when there is no obstruction to the
flow of CSF within the ventricular system. The condition arises either
due to inadequate absorption or due to an abnormal increase in the
quantity of CSF produced.
• subarachnoid/intraventricular haemorrhage, meningitis, and congenital
absence of arachnoid villi. Scarring and fibrosis of the subarachnoid
space following infectious, inflammatory, can also prevent
reabsorption of CSF, causing diffuse ventricular dilatation

13. • Non communicating hydrocephalus, also known as obstructive
hydrocephalus, occurs when the flow of CSF is blocked along one of
or more of the narrow passages connecting the ventricles. One of the
most common causes is aqueductal stenosis, a narrowing of the
aqueduct of Sylvius, a small passage between the 3rd and 4th ventricles
of the brain.

14. • Foramen of monro obstruction may lead to dilation of one or both
lateral ventricles.
• The aqueduct of Sylvius, obstruction may lead to dilation of both
lateral ventricles, as well as the third ventricle.
• Fourth ventricle obstruction leads to dilatation of the aqueduct, as well
as the lateral and third ventricles (Chiari malformation).
• The foramina of Luschka and foramen of Magendie may be obstructed
due to congenital malformation (Dandy–Walker malformation).

15. SYMPTOMS
INFANTS
• large head size (increasing head circumference)
• Bulging and tense fontanelle or soft spot
• Prominent scalp veins
• Downward deviation of eyes or sunset sign
• Vomiting
• Sleepiness
• Irritability
• Seizures

16. CHILDREN AND ADOLESCENTS
• Nausea and vomiting
• Swelling of the optic disc or papilledema
• Blurred or double vision
• high-pitched cry
• Balance and gait abnormalities
• Slowing or loss of developmental milstone
• Inability to concentrate
• Seizures
• Poor appetite
• Urinary incontinence

17. ADULTS
• Headache
• Nausea and vomiting
• Difficulty walking or gait disturbances
• Loss of balance or coordination
• Lethargy
• Bladder incontinence
• Impaired vision
• Impaired cognitive skills
• Memory loss
• Mild dementia

18. DIAGNOSIS • Crack pot sign
• Macewen Sunset sign

19. TESTING AND DIAGNOSIS
• Computed tomography scan (CT or CAT scan)
• Magnetic resonance imaging (MRI)
• Lumbar puncture (spinal tap)
• Intracranial pressure monitoring
• Isotope cisternography

20. MEDICAL MANAGEMENT
• Acetazolamide
• Furosemide
• Phenobarbitone
• Valproic acid
• Carbamazepine

21. SURGICAL
MANAGEMENT
• Endoscopic Third
Ventriculostomy (ETV)
• Shunt placement :
• Ventriculo Atrial shunt.
• Ventriculoperitoneal shunt
• Lumbo peritoneal shunt

22. PHYSIOTHERAPY MANAGEMENT
Short term goals:
1. Parents education and counselling
2. Stretching exercise
3. To facilitate supine to siting
4. To facilitate trunk control
5. To facilitate supine to sit and sit to stand activity
6. Improve strength of upper and lower limb
7. To facilitate fine motor activity
8. Functional task activity reach outs in different plane

23. Long term goal :
1. Improve balance and co-ordination
2. Gait training
3. Improve dexterity and fine movement of hand

24. RECENT ADVANCE
• A normal motor development in congenital hydrocephalus after
Cuevas Medek Exercises as early intervention: A case report
Author :Gabriela Ramires de Oliveira, Marcelo Fabris Vidal
Publish : 20 March 2020
Journal : clinical case report WILEY

25. • Vinod k poul, Om Prakash ghai, essential of paediatric , 8th edition
• Aruchamy lakshamana ,conical pediatrics ,history taking and casr
discussion,3rd edition.
• Estey CM. Congenital hydrocephalus. Veterinary Clinics: Small Animal
Practice. 2016 Mar 1;46(2):217-29.
• Sakka L, Coll G, Chazal J. Anatomy and physiology of cerebrospinal fluid.
European Annals of Otorhinolaryngology, Head and Neck Diseases. 2011
Dec 1;128(6):359-66.
• Rekate HL. A consensus on the classification of hydrocephalus: its utility in
the assessment of abnormalities of cerebrospinal fluid dynamics. Child's
nervous system. 2011 Oct;27(10):1535-41.
• Maller VV, Gray RI. Noncommunicating hydrocephalus. InSeminars in
Ultrasound, CT and MRI 2016 Apr 1 (Vol. 37, No. 2, pp. 109-119). WB
Saunders.
• Nervous System. 2020 Mar;36:577-82.
REFERENCES

26. • Mori K, Shimada J, Kurisaka M, Sato K, Watanabe K. Classification
of hydrocephalus and outcome of treatment. Brain and
Development. 1995 Sep 1;17(5):338-48.
• Karimzadeh P. Management of hydrocephalus. InHydrocephalus
2012 Feb 24. IntechOpen
• Dhandapani M, Yagnick NS, Mohanty M, Ahuja CK, Dhandapani S.
Clinical outcome, cognitive function, and quality of life after
endoscopic third ventriculostomy versus ventriculo-peritoneal shunt
in non-tumor hydrocephalus. Neurology India. 2021 Dec 1;69(8):556.
• Holwerda JC, Van Lindert EJ, Buis DR, Hoving EW, Dutch Pediatric
Neurosurgery Study Group. Surgical intervention for hydrocephalus
in infancy; etiology, age and treatment data in a Dutch cohort. Child's
Nervous System. 2020 Mar;36:577-82.

27. THANK YOU
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