Hydrocephalus could attack everyone in all age

I. Introduction
Most of perceptions about hydrocephalus have been formed in our society. But,
almost all of them are wrong. Generally, they said that hydrocephalus is a childhood
disease. Still from them, it is a head enlargement clinical manifestation disease. In fact,
not all of person with hydrocephalus have enlarged head. They do not know this disease
not only can be suffered by children but also teenager, adult and old man. Thus, this
disease can happen to people in all age. However, many cases were happened in
childhood, with clinical manifestation is head enlargement.
Getting no actual information about hydrocephalus has made the wrong
knowledge developed among people in society.
Because of that, this paper tries giving the right information about hydrocephalus,
especially about definition, different causes, symptoms, and effects of hydrocephalus in
different age. In order to, people do not perceive wrong again about it.

II. Body
Definition
Hydrocephalus was first described by the ancient Greek physician Hippocrates.
Hydrocephalus is a term derived from the Greek words “hydro” meaning water, and
“cephalus” meaning head, and this condition is sometimes known as “water on the
brain”. “Hydrocephalus is an excessive accumulation of cerebrospinal fluid (CSF) in the
cerebral ventricles, subarachnoid space, or subdual space” (Greenberg, Cindy Smith.
1985. Nursing Care Planning Guides For children, Hydrocephalus. USA. Williams and
Wilkins). This may cause increased intracranial pressure inside the skull and progressive
enlargement of the head so that may destroy nerves.
Clinical manifestation are primarily the signs of increased intracranial pressure.
Enlargement of the head is not happened to all of persons with hydrocephalus. Children
less than two years old with hydrocephalus have an enlarged head in associated with the
increased pressure because the cranial sutures have not yet closed. As the fluid
accumulates, the skull covering the brain becomes thin/ stretched and the scalp veins
become engorged. A hydrocephalic skull may have a somewhat alien appearance.

Epidemiologi
Hydrocephalus occurs in about one out of every 500 live births, making it one of
the most common birth defects, more common than Down Syndrome or deafness, and
was routinely fatal until surgical techniques for shunting the excess fluid out of the
central nervous system and into the blood or abdomen were developed.
According to the NIH website, there are an estimated 700,000 children and adults
living with hydrocephalus, and it is the leading cause of brain surgery for children in the
United States. There are over 180 different causes of the condition, one of the most
common being brain hemorrhage associated with premature birth.

Pathology
Hydrocephalus is usually due to blockage of CSF outflow in the ventricles or in
the subarachnoid space over the brain. In a normal healthy person, CSF continuously
circulates through the brain and its ventricles and the spinal cord and is continuously
drained away into the circulatory system. In a hydrocephalic situation, the fluid
accumulates in the ventricles, and the skull may become enlarged because of the great
volume of fluid pressing against the brain and skull. Alternatively, the condition may
result from an overproduction of the CSF fluid, from a congenital malformation blocking
normal drainage of the fluid, or from complications of head injuries or infections.
The elevated intracranial pressure may cause compression of the brain, leading to
brain damage and other complications. Conditions among affected individual vary
widely. Children who have had hydrocephalus may have very small ventricles, and
presented as the "normal case". This is the problem with this condition.
If the foramina of the fourth ventricle or the cerebral aqueduct are blocked,
cereobrospinal fluid (CSF) can accumulate within the ventricles. This condition is called
internal hydrocephalus and it results in increased CSF pressure. The production of CSF
continues, even when the passages that normally allow it to exit the brain are blocked.
Consequently, fluid builds inside the brain causing pressure that compresses the nervous
tissue and dilates the ventricles. Compression of the nervous tissue usually results in
irreversible brain damage. If the skull bones are not completely ossified when the
hydrocephalus occurs, the pressure may also severely enlarge the head. It is usually
happened to the children less than two years old whose cranial sutures have not yet
closed. The cerebral aqueduct may be blocked at the time of birth or may become
blocked later in life because of a tumor growing in the brainstem. Thus, the last can be
happened in teenager, adult or old man if they got tumor of brain.
Internal hydrocephalus can be successfully treated by placing a drainage tube
(shunt) between the brain ventricles and abdominal cavity to eliminate the high internal
pressures. There is some risk of infection being introduced into the brain through these
shunts, however, and the shunts must be replaced as the person grows
A subarachnoid hemorrhage may block the return of CSF to the circulation. If
CSF accumulates in the subarachnoid space, the condition is called external
hydrocephalus. In this condition, pressure is applied to the brain externally, compressing
neural tissues and causing brain damage. Thus resulting to a much further damage of the
brain tissue and leading to necrotization

Cause
Hydrocephalus can be caused by cerebrospinal fluid (CSF) flow obstruction, an
inability to reabsorb the fluid and excessive CSF production by choroids plexus. CSF
flow obstruction is the most common cause of hydrocephalus. It is hindering the free
passage of cerebrospinal fluid through the ventricular system and subarachnoid space.
For example :stenosis of the cerebral aqueduct or obstruction of the interventricular
foramina, foramina secondary to tumor, hemorrhage, infections or congenital
malformation.
Based on the causes hydrocephalus can be classified into communicating and non
communicating hydrocephalus.
1. Communicating hydrocephalus ( non obstructive hydrocephalus)
It is caused by inability to reabsorb CSF make excessive CSF in ventricles.
Various neurologic conditions may result in communicating hydrocephalus, including
subarachnoid/ intraventricular hemorrhage, meningitis, Chiari malformation and
congenital absence of arachnoiddal granulations (Pacchioni’s granulations). In neonatus,
it is caused by choroids plexus of neonatus that overgrowing, make more CSF is
produced than reabsorbed by arachnoidal villi. In other hand, many adults suffer this type
of hydrocephalus because of meningitis or other irritation. This type of hydrocephalus
also called as low or normal pressure hydrocephalus. Blood irritations in subarachnoid
space may cause communicating hydrocephalus that followed by dementia, fatigue, and
sometimes urinary incontinent.
2. non communicating hydrocephalus ( obstructive hydrocephalus)
It is caused by increased in production CSF and obstruction of the flow of CSF
through the ventricles. Foramen of monro obstruction may lead to dilation of one or, if
large enough both lateral ventricles. The aqueduct of sylvius, normally narrow to begin
with, may be obstructed by a number of genetically or acquired lesions (for example
atresia, ependymitis, hemorrhage, tumor) and lead to dilatation of both lateral ventricles
as well as the third ventricle. Fourth ventricle obstruction will lead to dilatation of the
aqueduct as well as the lateral and third ventricles. The foramina of Luschka and foramen
of Magendie may be obstructed due to congenital failure of opening for example in
Dandy-Walker malformation. The subarachnoid space surrounding the brainstem may
also be obstructed due to inflammatory or hemorrhagic fibrosing meningitis, leading to
widespread dilatation, including the fourth ventricle. Adult suffer obstructive
hydrocephalus usually because of tumor.

Symptoms
The symptoms of hydrocephalus are dependent upon the rate at which the fluid
accumulates, the age and the cause. Headaches, vormiting, nausea, papilledema,
sleepiness or coma or death are symptoms of increased intracranial pressure. Urinary
incontinence and dementia is a relatively typical manifestation of the distinct entity
normal or low pressure hydrocephalus ( communicating hydrocephalus). Children less
than 2 years old have an enlarged head in association with the increase pressure because
the cranial suture have not yet closed. But, adults do not have an enlarged head because
their cranial suture have closed. Focal neurological deficits may also occur, such as
abducens nerve palsy and vertical gaze palsy (Parinaud syndrome due to compression of
the quadrigeminal plate, where the neural centers coordinating the conjugated vertical eye
movement are located).

Effects
Because hydrocephalus injures the brain, thought and behavior may be adversely
affected. Learning disabilities are common among those with hydrocephalus, who tend to
score better on verbal IQ than on performance IQ, which is thought to reflect the
distribution of nerve damage to the brain.
However, the severity of hydrocephalus differs considerably between individuals
and some are of average or above average intelligence. Someone with hydrocephalus
may have motivation and visual problems, problems with coordination, and may be
clumsy. They may hit puberty earlier than the average child.
Infants and young children with hydrocephalus typically have abnormally large
heads, because the pressure of the fluid causes the individual skull bones — which have
not knitted with each other yet — to bulge outward at their juncture points. Compression
of the brain by the accumulating fluid eventually may cause convulsions and mental
retardation.
Because the problem resides inside the head, doctors rely heavily upon computer
tomography scanning (CT scans), which may be used frequently to evaluate the condition
of the disorder throughout the patient's life. Each CT scan exposes the patient to many
times the level of x-ray radiation of a chest x-ray. See CT radiation exposure.

Treatment

The treatment of hydrocephalus is aimed at decreasing the pressure either by

eliminating the cause or shunting the fluid to other parts of the body, from where it can be
reabsorbed. One of the most performed treatments for hydrocephalus, the cerebral shunt,
has not changed since it was developed in 1960. The shunt must be implanted through
neurosurgery into the patient's brain, a procedure which itself may cause brain damage.

It involves the placement of a ventricular catheter (a tube made of silastic), into the
cerebral ventricles to bypass the flow obstruction/malfunctioning arachnoidal
granulations and drain the excess fluid into other body cavities, from where it can be
reabsorbed. Most shunts drain the fluid into the peritoneal cavity (ventriculo-peritoneal
shunt), but alternative sites include the right atrium (ventriculo-atrial shunt), pleural
cavity (ventriculo-pleural shunt), and gallbladder. A shunt system can also be placed in
the lumbar space of the spine and have the CSF redirected to the peritoneal cavity (LP
Shunt). An alternative treatment for obstructive hydrocephalus in selected patients is the
endoscopic third ventriculostomy (ETV), whereby a surgically created opening in the
floor of the third ventricle allows the CSF to flow directly to the basal cisterns, thereby
shortcutting any obstruction, as in aqueductal stenosis. This may or may not be
appropriate based on individual anatomy.
An estimated 50% of all shunts fail within two years, requiring further surgery to
replace the shunts. In the past 25 years, death rates associated with hydrocephalus have
decreased from 54% to 5% and the occurrence of intellectual disability has decreased
from 62% to 30%.

Shunt Complication
Examples of possible complications include shunt malfunction, shunt failure, and
shunt infection. Although a shunt generally works well, it may stop working if it
disconnects, becomes blocked, or it is outgrown. If this happens the cerebrospinal fluid
will begin to accumulate again and a number of physical symptoms will develop, some
extremely serious. The shunt failure rate is also relatively high and it is not uncommon
for patients to have multiple shunt revisions within their lifetime.The diagnosis of
cerebrospinal fluid buildup is complex and requires specialist expertise.
Another complication can occur when CSF drains more rapidly than it is
produced by the choroid plexus, causing symptoms - listlessness, severe headaches,
irritability, light sensitivity, sound sensitivity, nausea, vomiting, dizziness, vertigo,
migraines, seizures, a change in personality, weakness in the arms or legs, excessive head
growth (seen infants, children under age 2), strabismus, and double vision - to appear
when the patient is vertical. If the patient lies down, the symptoms usually vanish in a
short amount of time.
 A CT scan may or may not show any change in ventricle size, particularly if the
patient has a history of slit-like ventricles. Difficulty in diagnosing overdrainage can
make treatment of this complication particularly frustrating for patients and their families.
Resistance to traditional analgesic pharmacological therapy may also be sign of
shunt overdrainage or failure. Diagnosis of the particular complication usualy depends on
when the symptoms appear.

III. Conclusion
Hydrocephalus is not a children disease because teenager, adult and old man also
could get it, as the effect of the other disease like cerebral hemorraghe, meningitis, brain
tumor, etc. there are two type of hydrocephalus, communicating hydrocephalus ( non
obstructive hydrocephalus) and non-communicating hydrocephalus ( obstructive
hydrocephalus). Many adult suffer communicating hydrocephalus and non
communicating hydrocephalus has been the big number of nerve surgical problem in
pediatric.
Children, less than two years old, with hydrocephalus have enlarged head in
association with the increased of pressure because the cranial sutures have not yet closed.
But adult don’t apply it because their cranial sutures have closed.
References
1. Greenberg, Cindy Smith. 1985. Nursing Care Planning Guides For children,
Hydrocephalus. USA. Williams and Wilkins.
2. Price, Sylvia A. and lorraine M. Wilson. 2006. Patofisiologi konsep klinis proses-
proses penyakit. Jakarta. EGC.
3. Nelson, behrman and kliegman Arvin. 1996. Ilmu Kesehatan Anak. Jakarta. EGC.
4. www.Wikipedia.com.
 English assignment
Hydrocephalus could attack everyone in all age

Oleh

RIMA NOVIA PUTRI

05121001

NURSING SCIENCE
MEDICINE OF FACULTY
ANDALAS UNIVERSITY