hydrocephalus

Defenition
• hydrocephalus is an enlargement of the brain's
ventricles due to an increase in css caused by an
imbalance between its production, circulation and
absorption.
Epidemiology
• 3: 1000 live births for congenital hydrocephalus
classification
Pathology
can be grouped as:

Obstructive (not communicating)

Non
-
obstructive (communicating)
- can be affected by impaired CSS balance, and also by
complications after infection or hemorrhagic complications.
• Etiology
• can be grouped as:
•
• Default (default)
• - often occurs in neonates or develops during intra-uterine.
•
• Acquired (acquired)
• -
• This condition affects children and adults, caused by subarachnoid bleeding,
intraventricular bleeding, trauma, infection (meningitis), tumors, surgical
complications or severe trauma to the head.
•
• Normal pressure hydrocephalus (NPH),
• This condition is generally experienced by the elderly (over 60 years).
Transferred with specific symptoms: gait disturbance, cognitive decline and
urinary incontinence
Etiology
• Brought disorders
•
• Sylvius aquaductus stenosis
• , is the most common cause of hydrocephalus in infants and children
(60-90%). The aquaductus can be a dead end or abnormally
narrower channel than normal. From birth it is born after being
proactive quickly in the first months after birth.
•
• Spina bifida and cranium bifida
• addition, hydrocephalus in this disorder is usually associated with
Arnord-Chiari syndrome interested in being attracted to the spinal
cord, with the medulla oblongata
• and sever the foramen magnum so that a partial blockage occurs
• or total.
• Dandy-Walker Syndrome
• , is a congenital forresia of the Luschkadan Magendi foramen with
obstructive hydrocephalus with widening of the ventricular system,
especially ventricular IV which can be developed large so that it is a
large cyst in the posterior fossa area
•
• Kistaarakhnoid
• , can occur congenital or due to trauma
• secondary hematoma.
•
• Blood anomaly
• , in the literature published happened hydrocephalus about arterio-
venous aneurysms about cerebral artery
• posterior to the Galeni vein or sinus tranversus due to obstruction
• aquaductus.
• Infection
• due to infection can arise attachment meningen
resulting in obliterasir subarachnoid space.
Ventricular dilation in the acute phase of
meningitispurulenta occurs if the flow of
cerebrospinal fluid is disrupted by obstructive
mechanism of purulent exudate where I can
activate Sylvius or the basal cysterna. Pathologically
visible thickening of the pyramid and arachnoid
tissue around the basal cistern in other areas. In
tuberculous serous meningitis, meningenter
attachment is mainly located in the basal area
• Neoplasm
• hydrocephalus by mechanical obstruction that can occur in any
• where cerebrospinal fluid flows. Treatment in this case is aimed at its
cause and if the tumor is inoperable, palliative action can be carried
out by flowing cerebrospinal fluid through the ducts or shunts. In
children, the most cases that cause ventricular IV blockage and the
Sylvius aquaductus are the last part usually of a glioma originating
from the cerebellum, whereas blockage of the front ventricular III is
usually caused by a craniopharyngeal.
• 4
• Bleeding
• it has been widely proven that bleeding before and after birth in the
brain can cause leptomeningen fibrosis especially in the regions
• basal brain, in addition to blockages that occur due to the
organization of the blood
• alone.
Diagnosis
• Neonates
• The most common symptom of hydrocephalus on
padaneonatus is irritability. Often children do not
want to eat and drink, eyes to the bottom (setting-
sun sign): white-colored skelera will appear above
the iris. , head enlarged, sometimes awareness
decreases towards lethargy. Children sometimes
vomit, rarely projectile. In this masaneonatus other
symptoms have not yet appeared, so if there are
symptoms such as the above, hydrocephalus
should be suspected.
•
• Children are less than 6 years old
• This head enlargement must be monitored from time to time, by measuring
• head circumference. In hydrocephalus a very similar sound will be heard
• with a knock on the watermelon. Older children will hear the sound of a
cracked jug (cracked-pot). This illustrates the existence of silk widening.
Veins on the scalp are very prominent, especially if the baby is
• cry. Increased ICT will force venous blood from the normal pathway at the
base
• the brain goes to the collateral system.
•
• Adult
• The most common symptom is headache. Meanwhile visual impairment,
motor disturbances and seizures occur in 1/3 casushidrosefalus in
adulthood. Neurological examination in general does not show
abnormalities, except for papillary edema and / or nerve paralysis
• abdusens.
• Radiology Overview
•
• Plain Head Photo
• Plain head photographs can provide important
information such as skull size, signs of increased
ICP, mass in the craniis fossa and abnormal
calcifications
•
• Ultrasound
• In the first 6-12 months of life, a diagnosis of
hydrocephalus
• can be established by ultrasound. Ultrasound will
appear dilated from ventricles but ultrasound is
very rarely used in diagnosing hydrocephalus.
•
• CTScan
• Mri
• Funduscopic Examination
• Funduscopic evaluation can reveal bilateral
papilledema when intracranial pressure increases.
The examination may be normal, however, with
acute hydrocephalus can provide a false
assessment.
Therapy
• Therapeutic conservative
• to limit the evolution of hydrocephalus through efforts to reduce
fluid secretion and choroid plexus (asetazolamit 100 mg / kgBB /
day; furosemide 1.2 mg / kgBB / day) or efforts to increase its
resorption (isorbide). The diatash therapy is temporary
•
• Therapeutology
• controlling cases that have vitamin A intoxication, re-directing
mass lesions that interfere with the flow of liquor, cleaning up the
remaining blood in liquor or repairing a malformation. In some
cases
• required to do temporary therapy first before
• the exact cause of the lesion is known; or still need surgery due to
cases that have multifactorial etiology or experience secondary
liquor flow disturbance.
• Ventriculoperitonealshunting
• The most common way to treat hydrocephalus. In
ventriculoperitoneal (VP) shunting, a tube is inserted through a
small hole in the skull into the space (ventricle) of the brain that
contains cerebrospinal fluid
• (CSF). This tube is connected to another tube that goes under the
skin to
• stomach, where it enters the abdominal cavity (peritoneal cavity).
Shunt allows CSS to flow out of the ventricles and into the
abdominal cavity where it is absorbed. Normally, valves in the
system help regulate fluid flow.
• Shunt
• installed on infants and children generally need to be replaced
with growth to fit their growing physique.It is estimated that
twice the installation procedure
• shunt
• will be done in children before they turn 10 years old.