Hydrocephalus symptoms and treatment ppt

Hydrocephalus

1. HYDROCEPHALUS Definition: Abnormal accumulation of CSF in the brain leading to increased pressure and increased ventricular size .

2. Embryology

3. Types of hydrocephalus Communicating /external /non obstructive hydrocephalus Non communicating/internal/obstructive hydrocephalus

4. Obstructive hydrocephalus level of obstruction - Foramen of munro: infection, hemorrhage,tumor - Aqueduct of sylvius : atresia, stenosis,gliosis - Fourth ventricle: SAH, meningitis, arnold chairi malformation - Foramina of magendie & luskha: dandy walker malformation , posterior fossa tumors.

5. Etiology Congenital causes - Intrauterine infections (toxoplasmosis, rubella, cytomegalovirus) Congenital malformations - Arnold chiari malformation - AV malformation - vein of galen malformation - Dandy walker syndrome Acquired causes - infections(meningitis, mumps meningoencephalitis, TORCH infections , cysticercosis) - inflammation :brain abcess - Posthemorrhagic (head injury, SAH) - posterior fossa tumors - Sagittal sinus thrombosis - Hypervitaminosis A

6. Pathogenesis Increased CSF production : choroid plexus papilloma Obstruction to the flow of CSF Decreased absorption : obstruction to outflow

7. Symptoms Headache and vomiting Blurred vision Drowsiness Horizontal diplopia Urinary incontinence(urgency, increased frequency)

8. signs

9. Differential diagnosis Normal pressure hydrocephalus Hydrocephalus ex vacuo Megalencephaly Hydraencephaly Subdural effusion Chronic subdural effusion

10. Investigations History Family history(for aqueduct stenosis) Past history : prematurity with intracranial hemorrhage, meningitis, mumps encephalitis Examination - Occipitofrontal head circumference - Anterior fontanelle - Back (abnormal midline skin lesions) - cranial bruit - Transillumination of skull - Eye examination

11. Plain Skull X ray - separation of sutures - Erosion of posterior clinoid process - Thinning out of the skull bones - Increased convolutional markings( Silver beaten appearance) Ultrasonogram (for hemorrhage) CT brain MRI brain

12. CT brain

13. MRI brain

14. Treatment Medical - Decreases CSF production: Acetazolamide and Furosemide - Increases CSF reabsorption : Isosorbide

15. Surgical treatment Shunt procedures

16. Complications: shunt malfunction Infection(ventriculitis) subdural hematomas post shunt dural fibrosis abdominal complications(ascites, pseudocyst , perforation of a viscus)

17. Lumboperitoneal shunt

18. Other surgical procedures Endoscopic third ventriculostomy Choroid plexectomy Choroid plexus coagulation Endoscopic cerebral aqueductoplasty Repeated lumbar puncture

19. ETV

20. Follow up Head circumference need to monitor Parents taught about signs of shunt infection or block Antibiotic prophylaxis in vascular shunts before dental procedure

21. References Nelson book of pediatrics , 21st edition Ghai essential pediatrics ,9th edition Thankyou I