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HYDROCEPHALUS

HYDROCEPHALUS. Dr. VASHDEV KHIMANI ASSISTANT PROFESSOR DEPT. OF NEUROSURGERY LUMHS JAMSHORO. Definition. Hydrocephalus derived from Greek word means water on brain. It is an abnormal accumulation of CSF in ventricles or cavities of brain. Functions of CSF. 1. Shock absorber

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HYDROCEPHALUS

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  1. HYDROCEPHALUS Dr. VASHDEV KHIMANI ASSISTANT PROFESSOR DEPT. OF NEUROSURGERY LUMHS JAMSHORO

  2. Definition Hydrocephalus derived from Greek word means water on brain. It is an abnormal accumulation of CSF in ventricles or cavities of brain

  3. Functions of CSF • 1. Shock absorber • 2. Delivering nutrients to the brain removing waste products. • 3. Flow between cranium & spine & compensate for changes in intracranial blood volume.

  4. Anatomy. Ventricular system is made up of 4 ventricles 2 lateral ventricles Third ventricle 4th ventricle

  5. Flow of CSF

  6. TYPES OF HYDROCEPHALUS Congenital: That present at birth Genetic defects (Aqueduct stenosis) Developmental defect (Neural tube defect) Intraventricular hemorrhage complication of premature birth.

  7. Aqueduct of Stenosis.

  8. Intraventricular Hemorrhage.

  9. Causes. • ACQUIRED: That present after the birth • Meningitis • Brain tumor • Traumatic head injury • Subarachnoid hemorrhage.

  10. Meningitis

  11. Brain tumor

  12. Traumatic head injury

  13. Subarachnoid hemorrhage.

  14. Normal pressure hydrocephalus (NPH) • Triad of(Gate disturbance, urinary incontinence, dementia ).

  15. NPH

  16. Ex vacuohydrocephalus Present when brain insult leads atrophy

  17. Ex vacuohydrocephalus

  18. PRESENTATION Pediatric age group Irritability, poor feeding, lethargic, vomiting, delayed milestones. SIGNS Increase OFC (occipitofrontal circumference) Visible scalp veins Sunset eye phenomenon Bulging fontenella

  19. Adult age group • Headache • Vomiting • Blurred vision • Dizziness • Altered level of consciousness • Papilloedema • Cushing triad (Bradycardia, Hypertension, Respiratory irregularities)

  20. Investigations Routine hematological Ultrasound brain CT scan brain MRI brain

  21. Ultrasound brain • Size of ventricles • Corticomantle thickness

  22. CT scan brain Normal Ctscan Abnormal Ctscan

  23. Ideal candidate for surgery When CSF is clear Patient is a febrile Normal CSF status Glucose 40-60mg/dl protein 15-40mg/dl Cells 0-5/cm predominantly lymphocyte

  24. When CSF is infectedLumber puncture / FontenellaTappingExternal ventriculostomy drain Flow is essence of life

  25. Lumber puncture

  26. Fontenella tapping

  27. External ventriculostomy drain

  28. Specific Treatment • Brain bypass surgery • Ventriculoperitoneal shunt • Ventriculoatrial shunt • Ventriculoplural shunt

  29. Complications of VP Shunt. • Shunt Malfunctioning. • Shunt block. • Shunt Infection. • Slit like

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