hydrocephalus

HYDROCEPHALUS

SUBMITTED BY:SAKSHI SRIVASTAVA MSC NSG FINAL YEAR JINSAR

HYDROCEPHALUS

HYDROCEPHALUSThe term Hydrocephalus comes from the two Greek words: 'hydro' which means water, and 'cephalus' which means head. In years past, it was commonly called 'water on the brain'. Put simply it is a condition where there is too much cerebrospinal fluid in the cranium

The balance between production and absorption of CSF is critically important. Ideally, the fluid is almost completely absorbed into the bloodstream as it circulates; however, there are circumstances which, when present, will prevent or disturb the production or absorption of CSF, or which will inhibit its normal flow. When this balance is disturbed, hydrocephalus is the result

ANATOMY AND PHYSIOLOGY OF CEREBROSPINAL FLUID

Cerebrospinal fluid (CSF) is found within the brain and the spinal cord. It is a clear, watery substance that flows through a channel into the space (subarachnoid space) around the brain and spinal cord, where it also functions as a cushion. The CSF is absorbed back into the bloodstream via mushroom-like structures over the brain

A small amount of CSF is produced by the spinal cord. The CSF contains nutrients and proteins necessary for the nourishment and function of the brain and carries waste products away from tissues in and around the brain

The fluid is produced within hollow channels in the brain called ventricles, primarily

within the lateral ventricle. In each ventricle is a specialized structure (which looks like

small flower-like tufts) called the choroid plexus, which is responsible for the majority of

CSF production

Congenital Hydrocephalus This means that Hydrocephalus is

present at birth. It is important to remember that this

term does not imply that it is hereditary. Often the exact cause of Congenital

Hydrocephalus cannot be determined but known causes can include:

Aqueductal Stenosis (non-communicating)

The most common cause of congenital Hydrocephalus is an obstruction called aqueductal

stenosis. When the long, narrow passageway between the third and fourth ventricles (see

‘What is Hydrocephalus’ diagram) is narrowed or blocked, perhaps because of infection,

haemorrhage or a tumour. Fluid accumulates "upstream" from the obstruction, producing

Hydrocephalus

Neural Tube Defect or NTD (communicating)

An open NTD, where the spinal cord is exposed at birth and is often leaking CSF, is often

referred to as Spina Bifida (see ‘What is Spina Bifida’). This kind of NTD causes part of

the cerebellum and the fourth ventricle to push downward through the opening at the base

of the skull into the spinal cord area, blocking CSF's flow out of the fourth ventricle and

producing Hydrocephalus

Arachnoid Cysts (non-communicating)

Arachnoids' Cysts may occur anywhere in the brain. In children, they're often located at

the back of the brain and in the area of the third ventricle. These cysts are filled with CSF

and lined with the arachnoid membrane. Some arachnoid cysts are self-contained, while

others are connected with the ventricles or the subarachnoid space. The fluid trapped by

the cysts may block the CSF pathways, producing Hydrocephalus

Acquired HydrocephalusThis means that Hydrocephalus has occurred after birth and can be caused by:

Intraventricular Hemorrhage (communicating)

An intraventricular haemorrhage, which most frequently affects premature newborns,

may cause an acquired form of Hydrocephalus. When small blood vessels alongside the

ventricular lining rupture, blood may block or scar the ventricles or plug the arachnoid

villi. The arachnoid villi is located in the second layer covering the brain which allows

CSF to be absorbed. When the CSF can't be absorbed, Hydrocephalus results.

Meningitis (communicating) Meningitis is an

inflammation of the membranes of the brain and spinal cord. Caused by

a bacterial or (less frequently) viral infection, meningitis can scar the delicate

membranes(meninges) that line the CSF pathway. An acquired form of Hydrocephalus

may develop if this scarring obstructs the flow of CSF as it passes through the narrow

ventricles or over the surfaces of the brain in the subarachnoid space.

Head Injury (communicating)A head injury can damage the brain's tissues, nerves, or blood vessels. Blood fromruptured vessels may enter the CSF pathway, causing inflammation. Sites of CSFabsorption might then be blocked by scarred membranes (meninges) or by blood cells.The CSF flow is restricted and Hydrocephalus develops

Brain Tumours (non-communicating)In children, brain tumors’ most commonly occur in the back of the brain (posteriorfossa). As a tumour grows, it may fill or compress the fourth ventricle, blocking the flowof CSF and causing Hydrocephalus. A tumors somewhere else in the brain might alsoblock or compress the ventricular system

Ventriculitis (non-communicating)Ventriculitis is a disease causing inflammation and or infection of the ventricles. It ismost common in infants and is often an extension of meningitis

CLINICAL MANIFESTATION:The signs and symptoms of

hydrocephalus vary generally by age of onset:

InfantsCommon signs and symptoms of hydrocephalus in infants include:

An unusually large head A rapid increase in the size of

the head

A bulging or tense soft spot (fontanel) on the top of the head

Vomiting Sleepiness Irritability Poor feeding Seizures Eyes fixed downward (sunsetting of

the eyes) Deficits in muscle tone and strength,

responsiveness to touch, and expected growth

Toddlers and older childrenAmong toddlers and older children,

signs and symptoms may include: Abnormal enlargement of a

toddler's head Headache Nausea or vomiting Fever Delays in walking or talking Problems with previously acquired

skills, such as walking or talking Blurred or double vision Unstable balance

Poor coordination Irritability Change in personality Problems with attention Decline in school performance Poor appetite Seizures Sleepiness Difficulty remaining awake or

waking up

Young and middle-aged adultsCommon signs and symptoms in this age group include:

HeadacheDifficulty in remaining awake or waking upLoss of coordination or balanceLoss of bladder control or a frequent urge to urinateImpaired visionDecline in memory, concentration and other thinking skills that may affect job performance. 

DIAGNOSTIC EVALUATION: Hydrocephalus is diagnosed through clinical neurological evaluation and by using cranial imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), or pressure-monitoring techniques. A physician selects the appropriate diagnostic tool based on an individual's age, clinical presentation, and the presence of known or suspected abnormalities of the brain or spinal cord.

MANAGEMENT: management for hydrocephalus includes 3 way

Medical management Surgical management Nursing management

Medical treatment is not effective in long-term treatment of chronic hydrocephalus. It may induce metabolic consequences and thus should be used only as a temporizing measure.

Medications affect CSF dynamics by the following mechanisms:

diuretics:acetazolamide po,iv decrease production of csf if progress of disease is slow

anticonvulsants:Phenobarbital prevents seizures

antibiotics:to prevent the shunt infection such as septicemia and meningitis.

SURGICAL MANAGEMENT: Hydrocephalus is most often treated by surgically inserting a shunt system. This system diverts the flow of CSF from the CNS to another area of the body where it can be absorbed as part of the normal circulatory process

VARIOUS TYPES OF SHUNT PROCEDURE Ventriculoperitoneal shunt (VP shunt) Ventriculopleural shunt (VPL shunt) Ventriculoatrial shunt (VA shunt) Lumboperitoneal shunt (LP shunt)

A shunt is a flexible but sturdy plastic tube. A shunt system consists of the shunt, a catheter, and a valve. One end of the catheter is placed within a ventricle inside the brain or in the CSF outside the spinal cord. The other end of the catheter is commonly placed within the abdominal cavity, but may also be placed at other sites in the body such as a chamber of the heart or areas around the lung where the CSF can drain and be absorbed.

Teach home care Encourage the child to participate in age-appropriate activities as tolerated. Encourage the parents to provide as normal lifestyle as possible. Remind both the child and parents that contact sports are prohibited.Explain how to recognize signs and symptoms of increased ICP. Subtle signs include changes in school performance, intermittent headache, and mild behavior changes.Arrange for the child to have frequent developmental screenings and routine medical checkups.

conclusion:The outlook for the hydrocephalic patient has changed dramatically over the past three decades as physicians caring for them have devoted themselves not only to developing innovative surgical techniques and improved hardware, but also to seeking a normal life-style for their patients.