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Hydrocephalus - Overview

Definition 

Hydrocephalus, also known as “water in the brain,” is a medical condition, presented mostly in babies, in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain.

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Treatment

  • The main therapeutic goal:  

    • improve CSF flow with surgical shunt placement

 

  • Medical treatments have been largely ineffective

    • Most often used when surgery is not available (palliative) and/or a bridge to surgery is required

      • Carbonic anhydrase inhibitors can decrease the rate of secretion of CSF to some extent, but does not relieve the obstruction

Etiologies

  • Congenital

  • Hemorrhage

  • Infectious/Inflammatory

  • Obstructive masses

  • Postoperative (Particular in pediatric posterior fossa procedures).

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Types of Shunts

  • Ventriculoperitoneal Shunt (VP Shunt)

  • Ventriculoatrial Shunt (VA Shunt)

  • Lumboperitoneal Shunt (LP Shunt)

Clinical Features 

  • Enlarged head

  • Emesis

  • Somnolence

  • Seizures

  • Cardiopulmonary distress

  • Mental retardation

  • Impaired motor function

  • Vision loss

  • Sunsetting eyes

  • Severely affected infants may not survive neonatal period

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Complications of Shunting

  • Infections

    • Staph, epidermis and staph, aureus 

  • Intracerebral/Subdural Hemorrhage

  • Over Shunting (VP shunts)

  • Misplacement

  • Seizures 

  • CSF Ascites

  • Clotting

  • Bacterial endocarditis

  • Primary mode of failure:  Obstruction of the catheter resulting in device replacement

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