CHILD HEALTH NURSING

Hydrocephalus (lectures) - by Mrs Sunita Bhandari (Shah)

Hydrocephalus is a term derived from the Greek words "hydro" meaning water, and "cephalus" meaning head and this condition is sometimes known as "water on the brain".
In other word hydrocephalus is abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head, convulsion, and mental disability

 
Causes
Congenital causes in infants and children
— Stenosis of the aqueduct of Sylvius
— Dandy-Walker malformation (congenital failure of opening)
— Agenesis of the foramen of Monro
— Congenital toxoplasmosis
 
 
Acquired causes in infants and children
— Mass lesions (20% of all cases in children, e.g. medulloblastoma, astrocytoma)
— Intraventricular haemorrhage (e.g.prematurity, head injury, or rupture of a vascular malformation)
— Infections - meningitis, cysticercosis in some areas
— Idiopathic
 
Epidemiology
— There is no cure for hydrocephalus.
— Hydrocephalus affects one in every 1000 live births,
— Making it one of the most common developmental disabilities, more common than Down syndrome or deafness.
— There are over 180 different causes of the condition, one of the most common being brain hemorrhage associated with premature birth.
 
Classification

Communicating

Communicating hydrocephalus, also known as non-obstructive hydrocephalus, is caused by impaired cerebrospinal fluid resorption in the absence of any CSF-flow obstruction due to functional impairment of the arachnoid granulations, Various neurologic conditions may result in communicating hydrocephalus, including subarachnoid/intraventricular hemorrhage, meningitis and congenital absence of arachnoidal granulations.
Hydrocephalus can also be caused by overproduction of cerebrospinal fluid.
Non-communicating

— Non-communicating hydrocephalus, or obstructive hydrocephalus, is caused by a CSF-flow obstruction (either due to external compression or intraventricular mass lesions).
— Foramen of Monro obstruction may lead to dilation of one or, if large enough both lateral ventricles. — The aqueduct of Sylvius. normally narrow to begin with, may be obstructed by a number of genetically or acquired lesions (e.g., atresia, ependymitis, hemorrhage, tumor) and lead to dilatation of both lateral ventricles as well as the third ventricle.
— Fourth ventricle obstruction will lead to dilatation of the aqueduct as well as the lateral and third ventricles. — The foramina of Luschka and foramen of Magendie may be obstructed due to congenital failure of opening (e.g., Dandy-Walker malformation).
— The subarachnoid space surrounding the brainstem may also be obstructed due to inflammatory or hemorrhagic fibrosing meningitis, leading to widespread dilatation, including the fourth ventricle.

 

 

Symptoms
— headaches,
— vomiting, nausea,
— papilledema,
— sleepiness,
— Coma.
— Gait instability,
— Urinary incontinence
— Dementia is a relatively typical manifestation of the distinct entity normal pressure hydrocephalus (NPH).
— Learning disabilities
 
 
Diagnosis
— The head circumference is essential for early diagnosis of neonatal hydrocephalus.
— CT/ MRI
— Physical examination : macewen’s sign or cracked- pot sound is elicited by percussion of skull. near the junction of the frontal, temporal and parietal bones will produce a stronger resonant sound when either hydrocephalus or a brain abscess are present.
amplified sound may be listened with the help of stethoscope
 
Management of the hydrocephalus
Non surgical treatment
1. Head wrapping: Muslin bandage firmly applied to the head, adhesive bandage and rubber bandage were also use to compress the head
2. Drug treatment : acetazolamide for reduce csf production
 

Surgical treatment :
Intracranial shunts: These procedures were done in case of obstructive hydrocephalus where the subarachnoid spaces are still patent.
Extracranial shunt
Third ventriculostomy
ventriculocisternostomy

 

Shunt complications

— Mechanical failure : Shunt blockage , Proximal occlusion , Shunt valve blockage, Distal obstruction
— Infection
 
Clinical features of shunt infection
— Shunt infection usually present early after shunt insertion within eight to ten weeks.
— Fever, malaise, headache, and irritability with some neck stiffness.