WILL WESTON4TH Year Medical Student

HYDROCEPHALUSIN CHILDHOOD

MOTHER’S PAST OBS HX…

1989: 10 Year Old Girl (Term + NVD)

1991: 8 Year Old Boy (Term + NVD)

1993: 6 Year Old Boy (Term + NVD)

BOBBY: 6 Year ♂

PREGNANCY & LABOUR…

Normal Pregnancy…up until… 33+4 / 40

…CTG: Fetal Distress (tachycardia)

ARM + Syntocinon

Vaginal Delivery

AFTER LABOUR…

APGAR: 9 @ 1 min; 9 @ 5 mins.

ECG: Supraventricular Extrasystole SCBU

Imaging: …

Interuterine Fetal Intercranial bleeding

(subarachnoid & interventricular haemorrhages)

Hydrocephalus

VP Shunt (10/3/00…aged 4/12)

HYDROCEPHALUS- DEF:Disturbance of …FORMATION / FLOW /ABSORPTION …

of CSF Volume occupied in the CNS.

HYDROCEPHALUS- DEF:Disturbance of …FORMATION / FLOW /ABSORPTION …

of CSF Volume occupied in the CNS.

FORMATION

FLOW

(indirectly inhibits absorption)

ABSORPTION

CAUSES:

CONGENITAL CAUSES IN INFANTS AND CHILDREN:

Stenoses of aqueduct of Sylvius due to malformation (10%):

Others:

Dandy-Walker malformation

Arnold-Chiari malformation type 1 and type 2

Agenesis of the foramen of Monro

Congenital toxoplasmosis

Bickers-Adams syndrome:

CAUSES:

ACQUIRED CAUSES IN INFANTS AND CHILDREN

Mass lesions: 20%

Intraventricular haemorrhage

Infections: Meningitis (especially bacterial).

Increased venous sinus pressure

Iatrogenic: E.g. Hypervitaminosis A

Idiopathic

SYMPTOMS… in Infants:

Poor feeding & Activity

Irritability & Vomiting

Head enlargement

Dysjunction of sutures & Tense fontanelle

Dilated scalp veins

Setting-sun sign: Characteristic in infants of ICP.

Increased limb tone

SIGNS… in Infants:

SYMPTOMS… in Children:

Slowing of mental capacity

Headaches, Vomiting & Drowsiness

Neck pain

Blurred vision

Double vision

Difficulty in walking

SIGNS… in Children:

Papilledema

SIGNS… in Children:

Papilledema

Failure of upward gaze

Macewen sign: "cracked pot“

Unsteady gait

Large head

Unilateral / bilateral 6th nerve palsy

INVESTIGATIONS:

ULTRASOUND (Evaluates intraventricular haemorrhage)

SKULL X RAY:

CT / MRI

INVESTIGATIONS:

ULTRASOUND (Evaluates intraventricular haemorrhage)

SKULL X RAY:

CT / MRI

MANAGEMENT- MEDICAL:

Used to delay surgical intervention.

May be tried in premature infants with posthemorrhagic hydrocephalus.

CSF Secretion by choroid plexus

Acetazolamide & Furosemide

CSF Reabsorption

Isosorbide (effectiveness is questionable)

MANAGEMENT- Sx (SHUNT):Establish communication between CSF and drainage cavity.

VENTRICULO-PERITONEAL (VP).

Lateral ventricle Peritoneum.

Advantage: No need to lengthen catheter with growth.

VENTRICULO-ATRIAL (VA)

Cerebral ventricles Jugular Vein SVC RA.

Used when patient has abdominal abnormalities

Others:

Lumboperitoneal / Torkildsen / Ventriculopleural.

MANAGEMENT- Sx (Others): Ventricular tap

Open ventricular drainage

LP in Posthemorrhagic & Postmeningitic hydrocephalus.

PROGNOSIS: Long-term outcome related directly to cause of hydrocephalus.

Up to 50% with large intraventricular haemorrhage Permanent hydrocephalus requiring shunt.

SINCE LABOUR…

Drug Hx:

No Known Allergies

All Relevant Immunisations

Movicol: Constipation

PMHx:

Occasional blocking of shunt, but currently satisfactory.

Asperger’s Syndrome (Special Ed at mainstream school)

Headaches

‘Trance like episodes’…

‘TRANCE LIKE EPISODES’…

Timing:

Occur in clusters (weeks - months apart) > often at school.

Frequency of Clusters: 2-3 / Episodes a week.

Duration of each episode lasting secs – mins.

Observations:

Staring blankly

Tachypnoea

Lasting

MANAGEMENT PLAN…

School Diary

Video Footage: Parents & Teachers’ Mobile Phones

EEG

Mental retardation, Cerebral palsy and EPILEPSY are known to be related to infantile hydrocephalus1,2

1. Persson EK, Hagberg G, Uvebrant P. Hydrocephalus prevalence and outcome in a population-based cohort of children born in 1989-1998. Acta Pædiatrica; 2005 Jun;94(6):726-32.

2. Battaglia D et al. Epilepsy in shunted posthemorrhagic infantile hydrocephalus owing to pre- or perinatal intra- or periventricular hemorrhage. J Child Neurol. 2005 Mar; 20 (3):219-25.

Any Questions