Neurology Book

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Hydrocephalus

Aka: Hydrocephalus, Chronic Hydrocephalus
  1. See Also
    1. Normal Pressure Hydrocephalus
  2. Definitions
    1. Hydrocephalus
      1. Increase in Cerebrospinal Fluid (CSF) volume in the central nervous system (CNS)
    2. Acute Hydrocephalus
      1. Neurologic Emergency
      2. Complete Obstructive Hydrocephalus
    3. Chronic Hydrocephalus
      1. Described below
      2. Results in Dementia
  3. Predisposing factors
    1. Meningitis
    2. Intraventricular Hemorrhage
    3. Meningomyelocele (Spina bifida)
  4. Pathophysiology
    1. Children
      1. Ventricular obstruction (noncommunicating)
        1. Aqueductal stenosis
        2. Incomplete Magendie or Luschka foramina development
      2. Associated with other neurologic abnormalities
        1. Microgyria or Macrogyria
        2. Porencephaly
        3. Agenesis of corpus callosum or cerebellar vermis
        4. Fusion of Cerebral Hemispheres
        5. Spina bifida, Meningocele or Encephalocele
        6. Syringomyelia or Hydromyelia
        7. Arnold-Chiari Malformation
    2. Adults
      1. Extraventricular obstruction (communicating)
        1. Occurs from subarachnoid space blockage
      2. Rarely Noncommunicating from aqueductal stenosis
  5. Causes
    1. Nonobstructive (ex vacuo)
      1. Alzheimer's Disease
      2. Pick's Disease
      3. Multiple Cerebral Infarctions
      4. Huntington's Disease
    2. Obstructive (Incomplete except in Acute Hydrocephalus)
      1. Adult: Communicating (Extraventricular Blockage)
        1. Post-Subarachnoid Hemorrhage
        2. Post-Meningitis
        3. Idiopathic Normal Pressure Hydrocephalus
      2. Child: Noncommunicating (Interventricular Blockage)
        1. Aqueductal stenosis
        2. Masses compressing the Fourth Ventricle
          1. Cerebellar tumor
        3. Foramen magnum malformation
          1. Arnold-Chiari Malformation
          2. Dandy-Walker Syndrome
  6. Symptoms
    1. Headache
    2. Vomiting
    3. Limb weakness
    4. Incoordination
  7. Signs
    1. Child
      1. Rapid increase in Head Circumference
      2. Bulging Anterior Fontanelle
    2. Adult
      1. Classic Triad of Normal Pressure Hydrocephalus
        1. Dementia of subcortical type
        2. Gait disturbance
        3. Incontinence
      2. Abulia
      3. Papilledema
      4. Eyes displaced downward
  8. Imaging
    1. Cranial Ultrasound (Infants)
      1. Requires open Anterior Fontanelle
      2. Shows ventricular enlargement
    2. CT Head
    3. MRI Head (preferred)
  9. Diagnosis
    1. CSF Flow study
      1. Radioiodinated Serum Albumin or radioactive indium
      2. Identifies obstruction site
  10. Management: Surgical Shunt (Ventriculoperitoneal Shunt)
    1. See Ventriculoperitoneal Shunt
    2. Needs to be done before irreversible neurologic loss
    3. Predictors of shunt efficacy in Hydrocephalus
      1. Symptoms for less than 6 months
      2. Lumbar Puncture efficacious
        1. Lowers CSF Pressure <100 mm
        2. Improves gait
  11. Management: Non-surgical
    1. Indicated when surgery not possible
    2. Acetazolamide (Diamox): Decreases CSF production
      1. Child: 10-25 mg/kg/day PO divided tid
      2. Adult: 250 mg PO tid
    3. Serial Lumbar Puncture (Temporize until surgery)
  12. Resources
    1. All About Normal Pressure Hydrocephalus
      1. http://www.allaboutnph.com

Hydrocephalus (C0020255)

Definition (MSH) Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, INTRACRANIAL HYPERTENSION; HEADACHE; lethargy; URINARY INCONTINENCE; and ATAXIA.
Definition (CHV) excessive gathering of cerebrospinal fluid within the head bone
Definition (CHV) excessive gathering of cerebrospinal fluid within the head bone
Definition (CHV) excessive gathering of cerebrospinal fluid within the head bone
Definition (CHV) excessive gathering of cerebrospinal fluid within the head bone
Definition (MEDLINEPLUS)

Hydrocephalus is the buildup of too much cerebrospinal fluid in the brain. Normally, this fluid cushions your brain. When you have too much, though, it puts harmful pressure on your brain.

Hydrocephalus can be congenital, or present at birth. Causes include genetic problems and problems with how the fetus develops. An unusually large head is the main sign of congenital hydrocephalus.

Hydrocephalus can also happen after birth. This is called acquired hydrocephalus. It can occur at any age. Causes can include head injuries, strokes, infections, tumors, and bleeding in the brain. Symptoms include

  • Headache
  • Vomiting and nausea
  • Blurry vision
  • Balance problems
  • Bladder control problems
  • Thinking and memory problems

Hydrocephalus can permanently damage the brain, causing problems with physical and mental development. If untreated, it is usually fatal. With treatment, many people lead normal lives with few limitations. Treatment usually involves surgery to insert a shunt. A shunt is a flexible but sturdy plastic tube. The shunt moves the cerebrospinal fluid to another area of the body where it can be absorbed. Medicine and rehabilitation therapy can also help.

NIH: National Institute of Neurological Disorders and Stroke

Definition (NCI_CTCAE) A disorder characterized by an abnormal increase of cerebrospinal fluid in the ventricles of the brain.
Definition (NCI_NCI-GLOSS) The abnormal buildup of cerebrospinal fluid in the ventricles of the brain.
Definition (NCI) A disorder characterized by an abnormal increase of cerebrospinal fluid in the ventricles of the brain.
Definition (CSP) excessive accumulation of cerebrospinal fluid within the cranium which may be a congenital or acquired disorder; hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions.
Concepts Disease or Syndrome (T047)
MSH D006849
ICD10 G91, G91.9
SnomedCT 267687006, 192807008, 154997008, 154995000, 230745008
English Hydrocephaly, Hydrocephalus, unspecified, HYDROCEPHALY, Hydrocephalus, hydrocephalus, hydrocephalus (diagnosis), Hydrocephalus NOS, Hydrocephalus [Disease/Finding], hydrencephaly, hydrencephalus, Water on the brain, HYDROCEPHALUS, NONSYNDROMIC, AUTOSOMAL RECESSIVE 1, HYC1, HYDROCEPHALUS, Hydrocephalus (disorder), hydrocephaly
French HYDROCEPHALIE, Hydrocéphalie SAI, Hydrencéphalie, Hydrocéphalie
Portuguese HIDROCEFALIA, Hidrocéfalo NE, Hidrocéfalo, Hidrocefalia
German HYDROZEPHALUS, Hydrozephalie, Hydrozephalus NNB, Hydrozephalus, nicht naeher bezeichnet, Hydrozephalus
Dutch hydrocefalus NAO, hydrocefalie, Hydrocefalus, niet gespecificeerd, hydrocefalus, Hydrocefalus
Italian Idrocefalo NAS, Idrocefalia, Idrocefalo
Spanish Hidrocefalia NEOM, Hidrocefalia, 1 hidrocefalia, HIDROCEFALIA, Hidrocéfalo, Hidrocéfalo Obstructivo, Hidrocéfalo Postraumático, Hidrocéfalo Comunicante, Hidrocéfalo Congénito, 1 hidrocefalia (trastorno), hidrocefalia (trastorno), hidrocefalia
Japanese 水頭症NOS, スイトウショウNOS, スイトウショウ, 水頭体, 水頭症, 水頭
Swedish Vattenskalle
Czech hydrocefalus, Hydrocefalus, Hydrocefalus NOS, Hydrocefalie
Finnish Hydrokefalus
Russian GIDROTSEFALIIA, ГИДРОЦЕФАЛИЯ
Korean 상세불명의 수두증, 수두증
Croatian HIDROCEFALUS
Polish Wodogłowie
Hungarian Hydrocephalus, Hydrocephalus k.m.n., Hydrocephalia
Norwegian Hydrocefalus, Hydrocephalus
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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