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HYDROCEPHALUS (Pediatrics)

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  1. excessive accumulation of CSF associated with progressive ventricular dilatation
  2. pathophysiology/etiology
    • increased production or CSF e.g. choroid plexus papilloma
    • decreased absorption of CSF e.g. hyperplasia of arachnoid villi, infection/hemorrhage destroying arachnoid villi
    • obstruction to flow of CSF e.g. congenital malformations (Dandy-Walker, Arnold-Chiari), masses, infections, congenital bone defects

Clinical Signs

 

  1. in utero - large head
  2. ventricular distention leads to stretching of the pathways surrounding ventricles which may cause
    • ataxia,
    • spasticity (lateral ventricle),
    • hypothalamic dysfunction (3rd)
    • impaired vertical gaze (4th)

 

Acute (increased ICP)

 

  1. irritability, lethargy, loss of appetite, vomiting
  2. large fontanelle; splayed sutures
  3. headache
  4. cranial nerve deficits
  5. herniation/coma


Chronic

 

  1. onset < 2 years: macrocephaly and excessive rate of head growth
  2. ataxia, spasticity
  3. papilledema, optic atrophy, impaired upward gaze,
  4. endocrine dysfunction (primarily causing growth failure)

Diagnosis

 

  1. prenatal ultrasound
  2. post natal ultrasound/CT/MRI

Treatment

 

  1. medical – treat underlying cause; acetazolamide (transiently decreases CSF production)
  2. surgical – remove lesion; ventriculoperitoneal shunt
HYDROCEPHALUS (Pediatrics) HYDROCEPHALUS (Pediatrics) Reviewed by Radiology Madeeasy on October 03, 2010 Rating: 5
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