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X:VIMSUPDATES 6AprilNew IAP UG Teacing Module · PDF fileNORMAL CSF PATHWAY. ... • TB meningitis – ATT • Pyogenic Meningitis ‐ Antibiotics 4 9. ... • Peritonitis • Arrhythmias

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Text of X:VIMSUPDATES 6AprilNew IAP UG Teacing Module · PDF fileNORMAL CSF PATHWAY. ... • TB...

HYDROCEPHALUS

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NORMALCSFPATHWAY

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NORMALCSFPATHWAY

HYDROCEPHALUS

IncreasedventricularsizeduetoincreaseinvolumeofCSFduetoeither Increasedproduction Obstruction Impairedabsorption

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HYDROCEPHALUS

1. Obstructivetype/noncommunicating Obstructioninventricularsystem

2. Nonobstructive/communicating Obliterationofsubarachnoidcisternsor

decreasedabsorption

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CAUSES

OBSTRUCTIVETYPE CONGENITAL

Aqueductalstenosis, ArnoldChiarimalformation, Dandywalkermalformation Spinabifida VeinofGalenaneurysm

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CAUSES

OBSTRUCTIVETYPE SPACEOCCUPYINGLESION

Intraventriculartumor, Posteriorfossatumor

VENTRICULARHEMORRHAGE Prematurity AVmalformation

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CAUSES

COMMUNICATINGTYPE DEFECTSINSUBAROCHNOIDSPACE

InfectionsCongenitalMeningitis(Pyogenicortubercular)

HemorrhageSubarachnoidTrauma

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CAUSES

COMMUNICATINGTYPE

ABNORMALITIESOFTHECSF OverproductionChoroidplexuspapilloma

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CAUSES

COMMUNICATINGTYPE

DEFECTOFCSFABSORPTION CongenitaldeficiencyofArachnoidGranulation

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PATHOPHYSIOLOGY

ObstructiontoCSFflow

Reversalofventricularfluidintoperiventricularwhitematter

Demyelinationandprogressivegliosis

Damagetoperiventricularwhitematterandlatergraymatter

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CLINICALFEATURES

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IncreasedHeadCircumferenceatBirth.

Rapidlyincreasingheadsize

CLINICALFEATURES

Neonatesandinfants Irritability Poorappetite, Vomiting Poorheadcontrol SunSettingsign Tensefontanelle,Delayedfusionofsutures

Dilatedscalpveins Macewansorcrackpotsignpositive(>1yrofage)

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CLINICALFEATURES

Olderchildren SignS/SraisedICT

Headache,worstinthemorning Nauseaandvomiting Papilledema Blurredvision Drowsiness/depressedlevelofconsciousness

Personalityandbehavioraldisturbances Gaitabnormalities

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SerialHCmeasurement/HCmorethan2std.

deviation

Papilledema

Abducenspalsy

Pyramidaltractlesions(lowerextremities)

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CLINICALFEATURES

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1. TYPEI

2. TYPEII

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ARNOLDCHIARIMALFORMATION

ARNOLDCHIARIMALFORMATION

TYPEI

NotassociatedwithHydrocephalus

Seeninadolescence

Headache,Neckpain

Progressivespasticity

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ARNOLDCHIARIMALFORMATION

TYPEII

LESIONfailureofpontineflexurein

embryogenesis

Elongationof4thventricle/kinkingofbrainstem

Displacementofmedulla,pons,vermiscervical

canal

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ARNOLDCHIARIMALFORMATIONII

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ARNOLDCHIARIMALFORMATION

TYPEII(CL.FEATURES)

INFANCY

weakcry

stridor

apnea

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ARNOLDCHIARIMALFORMATION

TYPEII(CL.FEATURES)

Progressivehydrocephalus Myelomeningocele

Abnormalityofgait

Spasticity

Incoordination

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Failureofdevelopmentofroofof4thventricle

Cerebellarhypoplasia

Cysticdilatationof4thventricle

Ass.Anomaliesabsenceofcorpuscallosum

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DANDYWALKERMALFORMATION

DANDYWALKERMALFORMATION

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DANDYWALKERMALFORMATION

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DANDYWALKERMALFORMATION

Clinicalfeatures Increasingheadsize

Prominentocciput

Cerebellarataxia

Delayedmotor&cognitivedevelopment

Transillumination

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TRANSILLUMINATION

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DIAGNOSISOFHYDROCEPHALUS

Increasedvelocityofheadgrowth

SeparatedsuturesSilverbeatenappearanceShalloworbit

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XRAYSKULL

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CTSCAN/MRIDILATEDVENTRICLES

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CTSCAN/MRIDILATEDVENTRICLES

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CTSCAN/MRIDILATEDVENTRICLES

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CTSCAN/MRIDILATEDVENTRICLES

TREATMENT

MEDICAL ReductionofCSFproduction

Acetazolamide50mg/kg/day

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TREATMENT

SURGICAL Reconstructionwithincranium DiversionofCSFtoextracranialsitesusingshunts

Ventricularatrial Ventriculoazygous Ventriculoperitoneal Thecoperitoneal

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VENTRICULOPERITONEALSHUNT

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VENTRICULOPERITONEALSHUNT

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VENTRICULOPERITONEALSHUNT

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VENTRICULOPERITONEALSHUNT

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VENTRICULOATRIALSHUNT

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THECOPERITONEALSHUNT

POSTSHUNTSURGERY

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1)Chabras

2)PudenzHakin

3)SplitzHoltervalve

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TYPESOFVPSHUNT

SPLITZHOLTERVALVE

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TREATMENT

1)Ventriculostomy

Openingofventricularsystemintosubarachnoidspacevialaminaterminalis.

2)Treatmentofcause:

TBmeningitisATT

PyogenicMeningitisAntibiotics

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COMPLICATIONSOFVPSHUNT

Blockage

Infection

Shuntdependence

SlitVentricleSyndrome

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COMPLICATIONSOFVPSHUNT

Migrationoftube

Intestinalobstruction

Peritonitis

Arrhythmias

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D/DOFLARGEHEAD

ChronicAnemia SECONDARY RicketsTOTHICKENED OsteogenesisImperfectaCALVARIUM EpiphysealDysplasia ChronicSubduralCollection MetabolicDisorders CerebralGigantism FamilialMegalencephaly Hydrancephaly

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ThankYou

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