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HYDROCEPHALUS

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DIVERSE GROUP OF CONDITIONS WHICH RESULT FROM IMPAIRED CIRCULATION ... NON OBSTRUCTIVE OR COMMUNICATING (MALFUNCTION OF ARACHNOID VILLI) CAUSES OF HYDROCEPHALUS ... – PowerPoint PPT presentation

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Title: HYDROCEPHALUS


1
HYDROCEPHALUS
  • Rene Santin, M.D.
  • Texas Tech University Health Sciences Center
  • Department of Pediatrics

2
HYDROCEPHALUS
  • DEFINITION
  • DIVERSE GROUP OF CONDITIONS WHICH RESULT FROM
    IMPAIRED CIRCULATION AND RESORPTION OF CSF.

3
CSF FORMATION
  • CSF IS FORMED BY THE CHOROID PLEXUS.
  • NORMAL CSF PRODUCTION 20 ml/h.

4
TYPES OF HYDROCEPHALUS
  • OBSTRUCTIVE OR NON-COMMUNICATING (OBSTRUCTION
    WITHIN THE VENTRICULAR SYSTEM)
  • NON OBSTRUCTIVE OR COMMUNICATING (MALFUNCTION OF
    ARACHNOID VILLI)

5
CAUSES OF HYDROCEPHALUS
  • LESIONS OR MALFORMATIONS OF THE POSTERIOR FOSSA
  • CHIARI MALFORMATION
  • DANDY- WALKER SYNDROME
  • TUMORS
  • IVH
  • MENINGITIS PNEUMOCOCCAL, TB
  • INTRAUTERINE INFECTIONS

6
PATHOLOGY
  • AQUEDUCTAL STENOSIS
  • ABNORMALLY NARROW AQUEDUCTUS OF SYLVIUS.
  • AQUEDUCTAL GLIOSIS
  • BRISK GLIAL RESPONSE OF EPENDIMAL LINING

7
CHIARI MALFORMATION
  • TYPE I
  • DISPLACEMENT OF CEREBELLAR TONSILS INTO THE
    CERVICAL CANAL.
  • GIVES SYMPTOMS IN ADOLESCENCE OR ADULT LIFE.
    (HEADACHE, NECK PAIN)
  • NO HYDROCEPHALUS.

8
CHIARI MALFORMATION
  • TYPE II
  • PROGRESSIVE HYDROCEPHALUS AND MYELOMENINGOCELE.
  • ELONGATION OF THE 4TH VENTRICLE.
  • DISPLACEMENT OF INFERIOR VERMIS, PONS, AND
    MEDULLA INTO CERVICAL CANAL

9
DANDY-WALKER SYNDROME
  • CYSTIC EXPANSION OF THE 4TH VENTRICLE IN THE
    POSTERIOR FOSSA.
  • DEVELOPMENTAL FAILURE OF ROOF OF 4TH VENTRICLE
    DURING EMBRYOGENESIS.
  • 90 HAVE HYDROCEPHALUS
  • PROMINENT OCCIPUT

10
IVH
  • DEFINITION
  • BLEEDING IN SUBEPENDIMAL GERMINAL MATRIX
    WITH/WITHOUT EXTENSION INTO VENTRICLES AND BRAIN
    PARENCHYMA
  • INCIDENCE
  • IN PREMATURES 25 - 40

11
IVH
  • PATHOLOGY
  • INTRAVASCULAR
  • VASCULAR
  • EXTRAVASCULAR
  • COMPLICATIONS
  • HYDROCEPHALUS
  • 20 IN MODERATE BLEEDS
  • 65-100 IN LARGE BLEEDS.

12
PREVENTION OF IVH
  • AVOID PROLONGUED LABOR OR DIFFICULT VAGINAL
    DELIVERY
  • AVOID PNEUMOTHORAX
  • AVOID OF HYPOTENSION OR HYPERTENSION IN THE
    NEONATE
  • AVOID HYPOXIC ISCHEMIC INSULT

13
PREVENTION OF IVH
  • INDOMETHACIN
  • PROPHYLACTIC FFP??
  • PROPHYLACTIC PLATELET TRANSFUSION???
  • PHENOBARBITAL???
  • VITAMIN E ???

14
CLINICAL MANIFESTATIONS
  • SYMPTOMS
  • IRRITABILITY
  • POOR FEED
  • LETHARGY
  • VOMITING
  • IN OLDER PATIENTS
  • HEADACHE
  • CHANGES IN PERSONALITY
  • ACADEMIC DETERIORATION

15
CLINICAL MANIFESTATIONS
  • SIGNS
  • ANTERIOR FONTANEL WIDE OPEN AND BULGING,
    INCREASED HEAD CIRC.
  • DILATED SCALP VEINS
  • SETTING SUN SIGN
  • BRISK TENDON REFLEXES, SPASTICITY
  • CLONUS, BABINSKY
  • MACEWEN SIGN CRACKED POT
  • PROMINENT OCCIPUT (DANDY-WALKER)

16
IMAGING STUDIES
  • X-RAY PLAIN FILMS
  • SEPARATION OF SUTURES
  • EROSION OF POSTERIOR CLINOIDS
  • INCREASED CONVOLUTIONAL MARKINGS (BEATEN SILVER
    APPEAREANCE)
  • ULTRASOUND
  • CT SCAN
  • MRI

17
THERAPY
  • MEDICAL
  • ACETAZOLAMIDE
  • FUROSEMIDE
  • SURGICAL
  • V-P SHUNT PLACEMENT

18
PROGNOSIS
  • INCREASED RISK FOR DEVELOPMENTAL DISABILITIES
  • MEAN IQ IS REDUCED COMPARED TO GENERAL POPULATION
  • ABNORMALITIES IN MEMORY
  • SOME PATIENTS SHOW AGGRESSIVE OR DELINQUENT
    BEHAVIOR.

19
PROGNOSIS
  • VISUAL PROBLEMS
  • STRABISMUS
  • VISUOSPATIAL ABNORMALITIES
  • DECREASED VISUAL ACUITY
  • VISUAL FIELD DEFECTS
  • PATIENTS REQUIRE LONG TERM FOLLOW UP
    (MULTIDISCIPLINARY)
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