HYDROCEPHALUS I.

Definition of Term

- It is the buildup of too much cerebrospinal fluid in the brain - It is also called as hydrodynamic disorder and water on the brain - Excessive accumulation of the CSF results in abnormal widening of space in the brain called ventricles - Can be congenital or acquired

Classifications: 1. Non-Obstructive or Communicating The flow of CSF is blocked after it exits the ventricles It is called communicating because the CSF can still flow between the ventricles, which remain open. Malabsorption occurs 2. Obstructive or Non-Communicating Normal flow of CSF is blocked along one or more of the narrow passages connecting the ventricles Can be caused by a tumor

II.

Risk Factors

In newborns: Abnormal development of the Central Nervous System Bleeding within the ventricles Infection in the uterus during a pregnancy In young children: Infections that affect the central nervous system Bleeding in the brain during or soon after delivery Injury before, during or after childbirth, including subarachnoid hemorrhage Tumors or lesions in the brain or spinal cord Injury or trauma to the brain

III.

Clinical Manifestations

Symptoms of hydrocephalus in infants include: Unusually large head High pitched crying or shrill cry Excessive sleepiness Bulging and tense fontanels Sun setting of the eyes Macewens sign Veins in the head are dilated Vomiting

Symptoms of hydrocephalus in young children include: Headache Nauseas and Vomiting Poor coordination Irritability Urinary incontinence Vision changes Seizures Excessive fatigue

IV.

Diagnostic Procedures

The diagnostic procedures in confirming hydrocephalus are: Head Ultrasound or Cranial Ultrasound (CUTZ) Magnetic Resonance Imagery CT Scan Physical Assessment Neurologic Exam

V. Medical Management A. Ventriculoperitoneal (VP) Shunt -Most common surgical treatment -Relieves intracranial pressure caused by hydrocephalus -Fluid is shunted from the ventricles of the brain into the abdominal cavity B. Ventriculoatrial (VA) Shunt -Removes fluid from the ventricles of the brain to a chamber of the heart

C. Third Ventriculostomy -A small opening is made in the bottom of the third ventricle to allow fluid to exit the brain

-It permits fluid to drain normally into the spaces outside the brain while bypassing any obstructions that are causing a backup, so the body can reabsorb the CSF back into the bloodstream as it normally would. Complications of Shunts: Mechanical failure or malfunction Infections Obstructions Increased ICP The need to lengthen or replace the catheter

VI.

Nursing Considerations Note for signs and symptoms of hydrocephalus Carefully measure head circumference daily Measure I & O of all fluids Monitor the nutritional status of the client Note that IV infusion should not be placed in the scalp Assist in performing diagnostic procedures Assist in shunt placement Obtain an informed consent Observe for complications after shunt has been placed Administer antibiotics for infections, as prescribed Observe for signs of increased intracranial pressure and infection Position the client on the non operative site after surgery

VII.

Pathophysiology
Precipitationg Factors:

Predisposing Factors: *Genetics *Age CSF forms in the choroid lexus of the lateral ventricle

*Prematurity *Infection *Hemorrhage *Tumor

Obstruction in the aqueduct of sylvius due to incomplete formation of lateral and media foramina Dilation of the third and lateral ventricle Increased intraventricular pressure and dilation of pathways proximal to the site of obstruction

Obstruction of CSF flow through the ventricular system Enlargement of ventricles disrupts the ventricular lining and then the underlying white matter Increase in water content due to transpendymal flow of CSF from elevated intraventricular and intracranial pressure Expansion of the skull, thinning and atrophy

Bulging and protrusion of the eyes; sunset eyes

Axonal and myelin destruction

Contraction of the cerebral blood volume

Enlarged head, bulging fontanel, shiny scalp, dilated scalp veins

Alteratin of cerebral circulation

Irritability, lethargy, sleepiness, reduced activity, vomiting and shrill cries Cranial Ultrasonography

CSF Circulation altered

Diagnostic Exams

CT Scan

MRI