HYDROCEPHALUS

• HYDROCEPHALUS, DEFINED AS ENLARGEMENT OF THE CEREBRAL

VENTRICLES, OCCURS WHEN PRODUCTION OF CSF OUTPACES THE
BODY’S ABILITY TO ABSORB THAT FLUID.
• IT IS DILATATION OF VENTRICLES DUE TO BLOCKAGE OF
CEREBROSPINAL FLUID FLOW (CSF) OR DUE TO INCREASED
SECRETION OR DUE TO DEFECTIVE ABSORPTION OF CSF.
 TYPES
• CLASSIFICATION 1
1. COMMUNICATING TYPE
2. NON-COMMUNICATING TYPE (OBSTRUCTIVE TYPE)

• THE DISTINCTION BETWEEN COMMUNICATING AND OBSTRUCTIVE

HYDROCEPHALUS IS DETERMINED BY THE NATURE OF CSF FLOW DISRUPTION.
• CSF DRAINS FROM LATERAL VENTRICLE TO 3RD VENTRICLE THROUGH
FORAMEN OF MONRO; FROM 3RD VENTRICLE TO 4TH VENTRICLE THROUGH
AQUEDUCT OF SYLVIUS; FROM 4TH VENTRICLE THROUGH FORAMEN OF
LUSCHKA AND MAGENDIE TO REACH OVER THE CONVEXITY TO GET ABSORBED
BY ARACHNOID TISSUE.
• IF THERE IS FREE FLOW OF SPINAL FLUID THROUGH THE VENTRICULAR SYSTEM
TO THE LEVEL OF THE ARACHNOID GRANULATIONS, THEN HYDROCEPHALUS IS
REFERRED TO AS COMMUNICATING.
• IF THERE IS OBSTRUCTION TO FLOW ANYWHERE IN THE VENTRICULAR SYSTEM,
THE HYDROCEPHALUS IS REFERRED TO AS OBSTRUCTIVE.
• RARELY, A TUMOR OF THE CHOROID PLEXUS, THE STRUCTURE RESPONSIBLE FOR
CSF PRODUCTION, WILL CAUSE OVERPRODUCTION OF THE SPINAL FLUID,
OUTPACING THE BODY’S ABILITY TO ABSORB IT.
• CLASSIFICATION 2
1. CONGENITAL : ASSOCIATED WITH SPINA-BIFIDA AND MYELOMENINGOCELE.
IT IS DUE TO
• FAILURE OF FORMATION OF CSF PATHWAYS
• CONGENITAL STENOSIS OF AQUEDUCT OF SYLVIUS
PRESENTS WITH WIDENING OF SUTURES, TENSE FONTANELLES AND DECREASED
CORTICAL THICKNESS . ENLARGEMENT OF HEAD OCCURS, EITHER PRENATAL (CAN
CAUSE OBSTRUCTED LABOR) OR POSTNATAL
2. ACQUIRED : MAY BE UNILATERAL OR BILATERAL (MIDLINE OBSTRUCTION)
DUE TO :
• CHRONIC MENINGITIS
• TRAUMA
• SUBARACHNOID HAEMORRHAGE
• BRAIN TUMOURS- (PINEAL/CEREBELLAR/ CRANIOPHARYNGIOMAS)
• COLLOID CYST OF 3RD VENTRICLE
• ARACHNOID CYSTS
• POSTHEMORRHAGIC HYDROCEPHALUS IS CAUSED BY OBSTRUCTION
OF THE ARACHNOID GRANULATIONS WITH BLOOD CELLS. THIS
RESULTS IN HYDROCEPHALUS OF THE COMMUNICATING VARIETY.
• POSTINFECTIOUS HYDROCEPHALUS IS ALSO COMMUNICATING AND
RESULTS FROM MENINGEAL INFECTION AND ALTERED CSF
ABSORPTION.
• NORMAL-PRESSURE HYDROCEPHALUS IS A CONDITION
CHARACTERIZED BY THE CLINICAL TRIAD OF GAIT ATAXIA,
INCONTINENCE, AND DEMENTIA. IMAGING REVEALS
VENTRICULOMEGALY OUT OF PROPORTION TO BRAIN ATROPHY. THIS
CONDITION IS MOST COMMONLY SEEN IN THE ELDERLY POPULATION
• CLINICAL FEATURES :
• LARGE HEAD OFTEN CAUSES OBSTRUCTED LABOR. THERE WILL BE
RAISED HEAD CIRCUMFERENCE MORE THAN 2 CM/MONTH AND
CRANIOFACIAL DISPROPORTION.
• BULGING OF ANTERIOR FONTANELLE WHICH IS MORE PROMINENT
ON CRYING, ENGORGED SCALP VEINS, SCALP IS THIN AND SHINY,
SUTURE LINE SEPARATION.
• DECREASED UPWARD GAZE (SUNSETTING SIGN); ON PERCUSSION
CRACKED POT SOUND DUE TO DILATED VENTRICLE (MACEWEN'S
SIGN).
• DELAYED MILESTONES, MENTAL RETARDATION AND DIFFICULTY IN
RETAINING FEEDS.
• FEATURES ON RAISED ICP MAINLY IN ADULT, LETHARGY,
IRRITABILITY, ATAXIA, PAPLLIOEDEMA, BLINDNESS DUE TO
OPHTHALMOPLEGIA, ABDUCENS PALSY AND RESPIRATORY
FAILURE.
• INVESTIGATIONS :
• CT SCAN
• MRI BRAIN
• CT OR AIR VENTRICULOGRAPHY
• TREATMENT :
1. MEDICAL :
• DRUGS-ACETAZOLAMIDE, FRUSEMIDE, ISOSORBIDE, GLYCEROL.

1. SURGICAL :
• TAPPING OF THE LATERAL VENTRICLES.
• VENTRICULOCYSTERNOSTOMY USING POLYTHENE CATHETERS
(TORKILDSEN OPERATION).
• ENDOSCOPIC THIRD VENTRICULOSTOMY.
• VENTRICULOATRIAL (VA) SHUNTS.
• VENTRICULOPERITONEAL (VP) SHUNTS.
THANK YOU !!!