Functional Classification

1. Obstructive HCP

Granulatio arachnoidea

2. Communicating HCP

ETIOLOGIES

Congenital

• Chiari type 1• Chiari type 2• Aqueductal stenosis• Dandy-Walker malformation

Acquired

• Post Infections : meningitis• Post hemorrhagic : SAH, IVH• Secondary to masses

• Non neoplastic : vasc malformation• Neoplastic, especially tumors around

aquaductus Medulloblastoma• Post op cerebral tumor removal

Arrested hydrocephalus• Compensated HCP• No progression or deleterious sequelae

due to HCP that would require shunt• Crit : near N ventricular size

N head growth curvecont’ psychomotor development

Family education : seek medical help if they develop symptoms of intracranial hypertension (headache, vomiting, ataxia, visual symptoms)

Diagnosis

• TH > 2mm• FH/ID > 0,5• Mickey mouse• Transependymal absorption• Evan’s ratio FH/BPD > 30% (N : 23-

27%)• Upward bowing corpus callosum

Signs and Symptoms

• Craniofacial disproportion• Irritability, poor head control• Fontanelle full and bulging• Enlargement scalp veins• Cracked pot sound (Macewen’s sign)• Abducens palsy• Sun set phenomen (upward gaze palsy)• Irregular respiration with apneic spells• Splaying of cranial suture (Xray)

DIFFERENTIAL DIAGNOSIS

•HCP ex vacuo(Atrophy cerebri)

•Hydrancephaly

Hydrocephalus ex vacuo

- enlargement of ventricles

- cerebral atrophy- usually aging- not true

Hydrancephaly

• Post neurulation defect• Absence of brain tissue supplied by ICA

but intack by PCA• Filled with CSF• HCP : cortical mantel +• In shunting : control head size, no re-

expansion• Kx : hyperirritable, no social smiling, retain

primitive reflexes, seizure• EEG : no cortical activity

TREATMENT

• Medical• Spinal taps• Surgical

Medical therapy

Diuretics

As adjunct to definitive treatment or as a temporizing measure

Acetazolamide25mg/kg/day (PO,TID)Increase until 100mg/kg/day

Furosemide1mg/kg/day(PO,TID)

Spinal taps

Ventricular or Lumbar taps

• In IVH serial taps until resorption resumes

• When resorption does not resume ( prot > 100mg/dl), usually need shunt

Complications of shunts

• Obstruction• Disconnection at a junction• Break• Infection• Hardware erosion through skin• Silicone allergy• Conduit for extraneural metastases

VP shunt complications• Inguinal hernia• Need tom lengthen with growth• Obstruction of peritoneal cath• Peritonitis• Hydrocele• Ascites• Tip migration in to scrotum• Perforation of viscus• Intestinal obstruction• Volvulus• Overshunting

Complications VA shunt

• Repeated lengthening • High risk of infection• Septicemia• Retrograde flow of blood in to

ventricles• Embolus• Vasc complications :

thrombophlebitis, perforation