Hydrocephalus was foremost described by the ancient Greek physicianHippocrates, but it remained an intractable status until the twentieth century, whenshunts and other neuro-surgicaltreatment modes were developed. Although 1 million Americans suffer from hydrocephaly, it remains a lesser-known medical status. Hydrocephalus affects both paediatric and big patients. Pediatric hydrocephalus affects one in every 500 unrecorded births, doing it one of the most commondevelopmental disablements, more common than deafnessor Down syndrome. It may besides be a heritable status and tallies in certain households largely impacting male childs. It is the taking cause of encephalon surgery for kids in theUnited States.
This paper will include an overview, marks, symptoms, pathophysiology, and intervention of hydrocephaly.
Definition of Hydrocephalus:
The term hydrocephaly is derived from the Grecian words “ hydro ” significance H2O and “ cephalus ” intending caput. It is a status in which the primary feature is inordinate accretion of fluid in the encephalon. Although hydrocephaly was one time known as “ H2O on the encephalon, ” the “ H2O ” is really cerebrospinal fluid ( CSF ) which is a clear fluid that surrounds the encephalon and spinal cord. The inordinate accretion of CSF consequences in an unnatural broadening of infinites in the encephalon called ventricles. This widening creates potentially harmful force per unit area on the tissues of the encephalon and do an increasedintracranial pressureinside theskulland progressive expansion of the caput, paroxysm, and mental disablement. Hydrocephalus can besides do decease.
Hydrocephalus comprises a extremely diverse group of upsets that have little in common except an addition in the volume of CSF within the intracranial fluid infinites. The causes of hydrocephalus associating to the altered pathophysiology and the age of the kid are summarized in below tabular arraies.
Types of Hydrocephalus:
1. Acquired hydrocephalus develops at the clip of birth or at some point subsequently. This type of hydrocephaly can impact persons of all ages and may be caused by hurt or disease.
2. Communicating hydrocephalus occurs when full communicating occurs between the ventricles and subarachnoid infinite. It is caused by overrun of CSF ( seldom ) , faulty soaking up of CSF ( most frequently ) , or venous drainage inadequacy ( on occasion ) .
• Arachnoid cyst
• Dandy-Walker deformity
• Associated with craniofacial syndromes
• Posthemorrhagic: intraventricular or subarachnoid
• Choroid rete villoma or choroid rete carcinoma
• Venous obstructor as in superior vein cava syndrome
• Aqueductal stricture
• Congenital lesions
( vena of Galen deformity, inborn tumours )
• Arachnoid cyst
• Chiari deformities either with or without myelomeningocele
• X-linked hydrocephaly
• Dandy-Walker deformity
• Aqueductal gliosis ( posthemorrhagic or postinfectious )
• Space-occupying lesions such as tumours or cysts
• Head hurts
3. Non- communication hydrocephaly occurs when CSF flow is obstructed within the ventricular system or in its mercantile establishments to the arachnidian infinite, ensuing in damage of the CSF from the ventricular to the subarachnoid infinite. The most common signifier of non-communicating hydrocephaly is clogging and is caused by intraventricular or extraventricular mass-occupying lesions that disrupt the ventricular anatomy.
4. Congenital hydrocephalus applies to the ventriculomegaly that develops in the fetal and babyhood periods, frequently associated with macrocephaly.The most common causes of inborn hydrocephaly are obstructor of the intellectual aqueduct flow, Arnold-Chiari deformity ormalformation. These patients may stabilise in ulterior old ages due to compensatory mechanisms but may decompensate, particularly following minor caput hurts. During these decompensations, finding the extent to which any new neurological shortages may be due to the new acute event, compared with hydrocephaly that may hold gone unnoticed for many old ages.
5. Internal Hydrocephalus Internal hydrocephaly refers to ventricular dilation and the associated pathophysiology. The term hydrocephaly is used most normally to mention to internal hydrocephaly.
6. External hydrocephalus External hydrocephaly refers to the accretion of CSF in either the subarachnoid or subdural infinites. CSF aggregation in the subarachnoid infinite may be a benign status in babyhood, which is called benign subdural hygromas of babyhood. CSF assorted with blood in the subdural infinite may non be benign and normally requires farther probe and intervention. It may be related to trauma. If these unstable aggregations exert force per unit area on the encephalon and cause symptoms or cause accelerated caput growing, surgical intervention may be necessary.
7. Ex Vacuo Hydrocephalus Ex vacuo hydrocephaly refers to a status of encephalon volume loss. The status may be present at birth. It may be the consequence of failure of the foetal development of the encephalon as in schizencephaly or hydranencephaly. The encephalon may besides undergo devastation or wasting from infections, really hapless nutrition, or unknown causes. The ventricles become big to “ make full the infinite ” where there is an absence of encephalon tissue, and may or may non be under increased force per unit area. There is technically non an instability of CSF production and soaking up, but instead there is a loss of encephalon affair.
8. Normal Pressure Hydrocephalus Normal force per unit area hydrocephaly is a status that occurs without increased intracranial force per unit area. There is ventricular dilation with compaction of the intellectual tissue, but the intraventricular force per unit area is normal. Patients develop symptoms easy over clip. The authoritative symptoms include dementedness, pace troubles, and urinary incontinency. This is chiefly a status of the aged.
Signs and Symptoms
The marks and symptoms of hydrocephalus vary by age group and disease patterned advance.
In babies, common marks and symptoms of hydrocephalus include:
- An remarkably big caput.
- A rapid addition in the size of the caput.
- A pouching “ soft topographic point ” on the top of the caput.
- Eyess fixed downward ( sun scene of the eyes ) .
- Developmental hold.
- A high-pitched call.
- Problems with sucking or eating.
- Unexplained, perennial emesis.
- Exhibiting an involuntariness to flex or travel the cervix or caput.
- Breathing troubles.
Irritability is the most common mark of hydrocephaly in babies. If this is non treated, it may take to lethargy. Bulging of the soft spots, or the soft musca volitanss between the skull castanetss, may besides be an early mark. When hydrocephalus occurs in babies, merger of the skull castanetss is prevented. This leads to unnatural enlargement of the skull.
In older kids and grownups, common marks and symptoms of hydrocephalus include:
- Headache followed by purging.
- Blurred or dual vision.
- Eyess fixed downward ( sun scene of the eyes ) .
- Problems with balance, coordination or pace.
- Lethargy or deficiency of energy.
- Decelerating or arrested development of development.
- Memory loss.
- Urinary incontinency.
- Changes in personality.
- Impaired public presentation in school or work.
- Walking troubles and failing.
- Impaired thought.
Pathophysiology of Hydrocephalus
Normal CSF production is 0.20-0.35 ml/min ; most CSFis produced by the choroid rete, which is located within the ventricular system, chiefly the sidelong and 4th ventricles. The capacity of the sidelong and 3rd ventricles in a healthy individual is 20 milliliter. Entire volume of CSF in an grownup is 120 milliliter.
Normal path of CSF from production to clearance is the undermentioned: From the choroid rete, the CSF flows to the sidelong ventricle, so to the interventricular hiatuss of Monro, the 3rd ventricle, the intellectual aqueduct of Sylvius, the 4th ventricle, the 2 sidelong hiatus of Luschka and 1 median hiatuss of Magendie, the subarachnoid infinite, the arachnidian granulations, the dural fistula, and eventually into the venous drainage.
ICP rises if production of CSF exceeds soaking up. This occurs if CSF is overproduced, opposition to CSF flow is increased, or venous fistula force per unit area is increased. CSF production falls as ICP rises. Compensation may happen through transventricular soaking up of CSF and besides by soaking up along nerve root arms. Temporal and frontal horns dilate first, frequently unsymmetrically. This may ensue in lift of the principal callosum, stretching or perforation of the septum pellucidum, cutting of the intellectual mantle, or expansion of the 3rd ventricle downward into the pituitary pit ( which may do pituitary disfunction ) .
The mechanism of NPH has non been elucidated wholly. Current theories include increased opposition to flux of CSF within the ventricular system or subarachnoid villi ; intermittently elevated CSF force per unit area, normally at dark ; and ventricular expansion caused by an initial rise in CSF force per unit area ; the expansion is maintained despite normal force per unit area because of the Laplace jurisprudence. Although force per unit area is normal, the hypertrophied ventricular country reflects increased force on the ventricular wall.
Normal tract of CSF
Pathophysiology of hydrocephaly
What is the current intervention?
There is presently no medical therapy that definitively treats hydrocephalus efficaciously. Occasionally, in marginal instances of progressive hydrocephaly and in PHH, water pills may be utile as a temporizing step to seek to avoid the demand for a lasting shunt. Acetazolamide, a carbonaceous anhydrase inhibitor, has been shown to diminish CSF production. The dosage may be every bit high as 100 mg/kg, and in order for it to be effectual, more than 99 % of carbonaceous anhydrase must be blocked before CSF production decreases significantly. Furosemide, 1 mg/kg/day, has besides been used. The mechanism of action is unknown, but it is thought to diminish encephalon extracellular fluid.
Hydrocephalus is most frequently treated by surgically infixing a shunt system. This system diverts the flow of CSF fromthe CNS to another country of the organic structure where it can be absorbed as portion of the normal circulatory procedure.
A shunt is a flexible but hardy plastic tubing. A shunt system consists of the shunt, a catheter, and a valve. One terminal of the catheter is placedwithin a ventricle inside the encephalon or in the CSF outside the spinal cord. The other terminal of the catheter is normally placed within the abdominal pit, but may besides be placed at other sites in the organic structure such as a chamber of the bosom orareas around the lung where the CSF can run out and be absorbed. A valve located along the catheter maintains one-way flow and regulates the rate of CSF flow.
A limited figure of persons can be treated with an alternate process called 3rd ventriculostomy. In this process, a neuroendoscope – a little camera that uses fiber ocular engineering to visualise little and hard to make surgical countries – allows a physician to see the ventricular surface. Once the range is guided into place, a little tool makes a bantam holein the floor of the 3rd ventricle, which allows the CSF to short-circuit the obstructor and flow toward the site of reabsorption around the surface of the encephalon.
Possible complications of a shunt system
Shunt systems are non perfect devices. Complications may include mechanical failure, infections, obstructors, and the demand to lengthen or replace the catheter. Generally, shunt systems require monitoring and regular medical follow up. When complications occur, the shunt system normally requires some type of alteration.
Some complications can take to other jobs such as overdraining or underdraining. Overdraining occurs when the shunt allows CSF to run out from the ventricles more rapidly than it is produced. Overdraining can do the ventricles to fall in, rupturing blood vass and doing concern, bleeding ( subdural haematoma ) , or slit-like ventricles ( slit ventricle syndrome ) .
Main complications of ventricular shunts
Underdraining occurs when CSF is non removed rapidly plenty and the symptoms of hydrocephalus recur. In add-on to the common symptoms of hydrocephaly, infections from a shunt may besides bring forth symptoms such as a low-grade febrility, tenderness of the cervix or shoulder musculuss, and inflammation or tenderness along the shunt piece of land. When there is ground to surmise that a shunt system is non working decently ( for illustration, if the symptoms of hydrocephalus return ) , medical attending should be sought instantly.
To sum up, hydrocephaly is a status ensuing from an instability between the production and soaking up of intellectual spinal fluid ( CSF ) . This instability consequences in an increased volume of spinal fluid, dilation of the ventricular system, and frequently increased intracranial force per unit area. The forecast for kids with hydrocephaly has markedly improved with modern shunting. The forecast of an baby or kid with hydrocephaly is largely dependent on the implicit in cause of the hydrocephaly. Hydrocephalus is subdivided into several different classs. Communicating and noncommunicating are the most common classs.
The pathophysiology of hydrocephaly is multifactorial. Aqueductal stricture, occlusion of the hiatus of Lushcka and Magendie, rhombencephalon herniation, annihilation of the subarachnoid infinites at the degree of the posterior pit, compaction of the sigmoid fistulas with attendant venous high blood pressure and fibrosis of the subarachnoid infinites, are the pathophysiological factors therefore far described.
The marks and symptoms of hydrocephalus vary depending on age, the grade of hydrocephaly at presentation, the primary etiology, and the clip over which the hydrocephaly develops. Because of the malleability of the baby encephalon and the ability of the braincase to spread out, ventriculomegaly can come on without obvious marks of increased intracranial force per unit area.
There is presently no medical therapy that definitively treats hydrocephalus efficaciously. CSF shunting is the most common standard surgical intervention in the long-run direction of hydrocephaly. However, most complications arise from malfunction or infection
Cartwright, C. , & A ; Wallace, D. ( 2007 ) . Nursing Care of the Pediatric Neurosurgery Patient. New York: Springer Berlin Heidelberg.
Espay, J. ( 2009 ) . E Medicine. Hydrocephalus. Retrieved on DEC17, 2009 from HYPERLINK “ hypertext transfer protocol: //emedicine.medscape.com/article/1135286-overview ” hypertext transfer protocol: //emedicine.medscape.com/article/1135286-overview
National Institute of Neurological Disorders and Storke. ( 2008 ) . Hydrocephalus Fact Sheet. Retrieved on Dec 17, 2009 from HYPERLINK “ hypertext transfer protocol: //www.ninds.nih.gov/disorders/hydrocephalus/detail_hydrocephalus.htm ” hypertext transfer protocol: //www.ninds.nih.gov/disorders/hydrocephalus/detail_hydrocephalus.htm
Mayoclinic. ( 2009 ) . Hydrocephalus. Retrieved on Dec 17,2009 from
hypertext transfer protocol: //www.mayoclinic.com/health/hydrocephalus/DS00393/DSECTION=symptoms
-zek, M. , Cinalli, G. , & A ; Maixner, W. ( 2008 ) . The Spina Bifida: Management and Outcome. Milan: Springer-Verlag.
Smith, J. , & A ; Martin, C. ( 2009 ) . Pediatric neurosurgery for nurses. New York: Routledge.
Wikipedia, the free encyclopaedia. Hydrocephalus. Retrieved on Dec17 from HYPERLINK “ hypertext transfer protocol: //en.wikipedia.org/wiki/Hydrocephalus ” hypertext transfer protocol: //en.wikipedia.org/wiki/Hydrocephalus