Hydrocephalus
Macrocephaly is defined as a head circumference greater than 2 standard deviations above the mean for age and sex. It can be caused by increased skull size due to conditions like chronic anemia or increased brain size. Hydrocephalus, an excessive accumulation of cerebrospinal fluid in the brain ventricles, is another potential cause. Hydrocephalus can be obstructive due to blockages or non-obstructive if caused by increased fluid production or decreased absorption. Symptoms include irritability, poor feeding, lethargy and vomiting. Diagnosis involves medical history, physical exam, and brain imaging studies like CT or MRI scans. Treatment options include supportive care, medications to reduce fluid production, and surgical placement of a VP
Hydrocephalus
- 1. MACROCEPHALY ANU PRIYA
- 2. MACROCEPHALY Head circumference >2 S.D./>2.5cm above the mean for the age and sex Head circumference >97th percentile for the age and sex Expected HC for a particular child by comparing with standardized charts
- 3. Causes Big skull-chronic anemia,osteogenesis imperfecta,rickets Big brain-megalencephaly(tay-sach),cerebral gigantism More CSF in ventricles-hydrocephalus Abnormal accumulation-subdural effusion Familial-commonest cause
- 4. HYDROCEPHALUS (Greek-water in head) DEFINITION: Excessive accumulation of CSF in the ventricular system
- 5. TYPES OF HYDROCEPHALUS OBSTRUCTIVE OR NON-COMMUNICATING -at the level of aqueduct 3 mm long & 2 mm wide NON OBSTRUCTIVE OR COMMUNICATING -increased production -decreased absorption
- 6. CAUSES OF HYDROCEPHALUS COMMUNICATING HYDROCEPHALUS Increased Production • Tumors in choroid plexus Decreased Absorption Congenital-TORCH Acquired-Meningitis,leukemia
- 7. CAUSES OF HYDROCEPHALUS • OBSTRUCTIVE HYDROCEPHALUS Congenital Aqueductal stenosis Arnold chiari syndrome Dandy-walker syndrome Acquired Aqueductal gliosis- meningitis,bleeding,mumps encephalitis Posterior fossa tumors-medulloblastoma
- 8. CLINICAL MANIFESTATIONS SYMPTOMS: IRRITABILITY POOR FEED LETHARGY VOMITING
- 9. CLINICAL MANIFESTATIONS SIGNS: Before AF closure -BULGING ANTERIOR FONTANEL, -INCREASED HEAD CIRC. -DILATED SCALP VEINS -SETTING SUN SIGN -WEAKNESS OF LOWER LIMBS
- 10. • After AF closure -Headache,vomiting -Blurring of vision -Bradycardia,increased Bp -6th CN Palsy -Papilloedema -Transillumination Test -Macewen Sign “Cracked Pot” -Prominent Occiput (Dandy-walker)
- 11. DIAGNOSIS History 1.Prematurity 2.Intrauterine infections 3.Intracranial hemorrhage 4.Meningitis 5.Mumps encephalitis
- 12. On examination 1.Café-au-lait patches 2.Spinal dysmorphism 3.Wide AF,wide sutures,sunset eye sign 4.Lower limb weakness,cranial bruit 5.Chorioretinitis,papilloedema
- 13. IMAGING STUDIES PLAIN X-RAY SKULL: SEPARATION OF SUTURES EROSION OF POSTERIOR CLINOIDS INCREASED CONVOLUTIONAL MARKINGS (SILVER BEATEN APPEAREANCE) ULTRASOUND CT SCAN MRI
- 14. TREATMENT SUPPORTIVE:(control of ICP) a.head elevated to 30o b.Control of temperature c.Control of seizures d.Maintain BP e.Analgesia and sedation
- 15. TREATMENT MEDICAL: (for decreasing the production) _ MANNITOL/ORAL GLYCEROL -ACETAZOLAMIDE -FUROSEMIDE SURGICAL:(for obstruction and decreased absorption) V-P SHUNT PLACEMENT
- 16. PROGNOSIS INCREASED RISK FOR DEVELOPMENTAL DISABILITIES MEAN IQ IS REDUCED COMPARED TO GENERAL POPULATION ABNORMALITIES IN MEMORY SOME PATIENTS SHOW AGGRESSIVE OR DELINQUENT BEHAVIOR.
- 17. PROGNOSIS VISUAL PROBLEMS: STRABISMUS VISUOSPATIAL ABNORMALITIES DECREASED VISUAL ACUITY VISUAL FIELD DEFECTS PATIENTS REQUIRE LONG TERM FOLLOW UP
Editor's Notes
- #8: Aqueductal stenosis-TORCH malformation of aque,aneurysmal diln of vein of Galn