Hydrocephalus

Learning Objectives
To know
What is Hydrocephalus?
Causes of Hydrocephalus?
Types of Hydrocephalus?
To Learn
Signs and symptoms
Diagnosis and Evaluation
To know
Types of Treatment
Physical Therapy treatment
Hydrocephalus /water in the brain
 Hydrocephalus is a medical condition in which
there is an abnormal accumulation of
cerebrospinal fluid in the ventricles or cavities of
the brain.
 This may cause an enlargement in the head,
convulsions, tunnel vision and mental disability.
Hydrocephalus can also cause death. The name
derives from the Greek word “Hydro” meaning
water and “cephalus” meaning head .
Cause
The cause of this disease is
from impaired
cerebrospinal fluid and over
production of the
cerebrospinal fluid. Its
transmitted by genetics. In
infants with hydrocephalus
the CSF, builds up in the
central nervous system,
causing the soft spot of the
Childs head to bulge and
grow larger than expected.
How the condition affects the CNS.
The CSF fluid of Hydrocephalus pushes the brain up against the skull
and damage the brain tissue. It can injure the brain permanently and it
can cause mental and physical development issue, it’s usual very fatal.
TYPES OF HYDROCEPHALUS
Obstructive Or Non-communicating (Obstruction
Within The Ventricular System)

Non Obstructive Or Communicating (Malfunction

Of Arachnoid Villi)
Communicating hydrocephalus
Communicating hydrocephalus occurs when the flow
of CSF is blocked after it exits the ventricles.

This form is called communicating because the CSF

can still flow between the ventricles, which remain
open. 
Non-communicating hydrocephalus
Non-communicating hydrocephalus - also called
"obstructive" hydrocephalus - occurs when the flow
of CSF is blocked along one or more of the narrow
passages connecting the ventricles.
One of the most common causes of hydrocephalus is
"aqueductal stenosis." In this case, hydrocephalus
results from a narrowing of the aqueduct of Sylvius, a
small passage between the third and fourth ventricles
in the middle of the brain.
Types
Congenital hydrocephalus, which is present at
birth. Congenital hydrocephalus may be caused by
physical problems with how CSF flows or is made or
absorbed, by infections or trauma during fetal
development, or by teratogens. It may be linked with
other birth defects that affect the spine, especially
open neural tube defects.
Acquired hydrocephalus, which develops at the
time of birth or later. It can be caused by infections
such as meningitis, bleeding, injury, or a tumour.
 Types
Normal-pressure hydrocephalus, which usually
develops in people who are age 55 or older. It is a
potentially treatable cause of dementia. This type of
hydrocephalus often occurs after head trauma,
infections, and bleeding within the brain.
What causes hydrocephalus?
 The causes of hydrocephalus are still not well
understood.
 Hydrocephalus may result from inherited genetic
abnormalities (such as the genetic defect that causes
aqueductal stenosis)
 Developmental disorders (such as those associated
with neural tube defects including spina bifida and
encephalocele).
Other possible causes include complications of
premature birth such as intraventricular hemorrhage,
diseases such as meningitis, tumors, traumatic head
injury, or subarachnoid hemorrhage, which block the
exit of CSF from the ventricles to the cisterns or
eliminate the passageway for CSF into the cisterns
Symptoms for children/Infants
Unusually large head size
Vomiting
Sleepiness
Irritability
Downward deviation of the eyes (sun setting- eyes
rotating or downward with sclera visible above
pupil)
Seizures
Symptoms for older children/Adults.
Brief, shrill, high-pitched cry
Changes in personality, memory, or the ability to reason or think.
Changes in facial appearance and eye spacing
Crossed eyes or uncontrolled eye movements
Difficulty feeding
Excessive sleepiness
Headache Irritability
poor temper control
Loss of bladder control (urinary incontinence)
Loss of coordination and trouble walking
Muscle spasticity (spasm)
Slow growth
Diagnostic Evaluation
Antenatal- fetal ultrasound as early as 14 weeks

Infancy- based on head circumference crosses one or more

grid lines on the infant growth chart within a 4 week period
and there are progressive neuro signs.

CT and MRI to localize site of obstruction; reveal large

ventricles
 Evaluation:
Physical Therapy is an integral part of the
hydrocephalus multi-disciplinary team.

The physical therapist performs testing of function,

balance, and gait disturbances typical of a patient with
hydrocephalus.
How can physiotherapy help after hydrocephalus?
Excessive pressure on the brain can result in physical problems
in babies or children which may affect their physical
development, achievement of milestones, balance, coordination
or mobility. Team of specialist pediatrics physiotherapists can
provide treatment of a child’s physical problems in order to
maximise their potential and quality of life. Aims of treatment
will vary according to the child’s needs and age but may
include:

Promoting achievement of physical milestones such as sitting,

standing, crawling, walking

Maximising independence in mobility

Cont..
Exercises to improve balance and coordination

Exercises to stretch or strengthen tight or weak

muscles

Improving confidence and quality of life

Improving tolerance and stamina

 Physical therapy Treatment:

 Physical Therapy will address common secondary difficulties

associated with hydrocephalus such as strengthening, stretching,
neuromuscular re-education, balance training, development of
gross motor skills such as walking, and increased independence
with functional daily tasks.

 Higher-level learning takes place through problem-solving by the child

rather than by the therapist's hands-on facilitation.

 Emphasis has also been placed on the importance of family-centered

care, transdisciplinary service, and treatment in natural environments.
 Surgical management
Hydrocephalus is most often treated by surgically inserting a shunt system. This
system diverts the flow of CSF from the CNS to another area of the body where it
can be absorbed as part of the normal circulatory process.

A shunt is a flexible but sturdy plastic tube. A shunt system consists of the shunt,
a catheter, and a valve. One end of the catheter is placed within a ventricle inside
the brain or in the CSF outside the spinal cord.

The other end of the catheter is commonly placed within the abdominal cavity,
but may also be placed at other sites in the body such as a chamber of the heart
or areas around the lung where the CSF can drain and be absorbed. A valve
located along the catheter maintains one-way flow and regulates the rate of CSF
flow.
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 (Lumbar-peritoneal shunt)
Prognosis
The prognosis for individuals diagnosed with
hydrocephalus is difficult to predict, although there is
some correlation between the specific cause of the
hydrocephalus and the outcome.
 Prognosis is further complicated by the presence of
associated disorders, the timeliness of diagnosis, and
the success of treatment.
The degree to which relief of CSF pressure following
shunt surgery can minimize or reverse damage to the
brain is not well understood.