Hydrocephalus for slide share

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  1. 1. MACROCEPHALY Dr. D. Gunasekaran, Consultant Paediatrician, MGMC & RI, Pondicherry
  2. 2. Macrocephaly - Definition > 2 S.D above the mean for the age & sex OR > 97th percentile for the age & sex OR > 2.5 cms above the mean for age & sex
  3. 3. Macrocephaly How to find out the expected HC for a particular child? Only by comparing the standardized charts which shows HC for a particular age & sex
  4. 4. Normal HC at birth At birth 33-35cm 5 mm) Broad forehead Prominent subcutaneous veins Sun-set eyes (dilated suprapineal recess impinges on the tectum, midbrain, which controls eye movements) Weakness of lower limbs (stretching and disruption of CS fibres originating from the leg region of the motor cortex, while crossing over the dilated ventricles)
  5. 22. Prominent subcutaneous veins
  6. 23. Clinical features after AF closure - ICT Headache, vomiting Blurring of vision -stooping and bending Bradycardia, increase in BP (Cushings triad ICT disturbs the vasomotor centre in Medulla) 6th CN palsy (often unilateral) Papilloedema Transillumination (2.5cm & 1cm)- (when there is massive dilatation of the ventricles or in Dandy- Walker syndrome)
  7. 24. Clinical features after AF closure - ICT Macewan sign (crack pot sound - significant only after the AF & sutures close) Small occiput Arnold Chiari Prominent occiput Dandy-walker
  8. 25. Diagnosis 1. History:- Familial: X linked or AR Aqueductal stenosis Prematurity Intra uterine infection Intracranial hemorrhage Meningitis Mumps Encephalitis (leads to aqueductal stenosis) 2. 0/E: Caf-au-lait patches (NC markers) Spinal dysraphism (tufts of hair, lipoma, angioma) Wide AF, wide sutures, sun set eye sign, LL weakness Cranial bruit (AV Malformation of Galen) Transillumination +: massive dilatation of ventricles; D. W. syndrome Eye: Papillodema, chorioretinits
  9. 26. Diagnosis -Investigations 1. X-Ray skull:- Infant: Older child: In long standing cases:
  10. 27. Diagnosis -Investigations 1. X-Ray skull:- Infant: Calcification (IU infection) Separated sutures Older child: Thinning of the floor of the sella Erosion of the posterior clinoids In long standing cases: Silver-beaten appearance (an increase in convolution markings)
  11. 28. Diagnosis - Investigations 2. USG (through AF), CT scan & MRI:- Dilatation of all ventricles: communicating type 3rd ventricle dilatation & 4th ventricle normal: Aqueductal stenosis
  12. 29. Treatment Supportive- Control of ICP 1. Head elevated to 30 deg & in neutral 2. Control of temperature 3. Control of seizures 4. Maintain blood pressure 5. Analgesia & sedation
  13. 30. Treatment Supportive- Control of ICP Hypertonic solutions:- Mannitol or Oral glycerol Passive hyperventilation:- Decline of PCO2 Mild constriction of blood vessels in brain Mild (10-30%) reduction of ICT
  14. 31. Treatment For decreasing the production:- Acetazolamide temporary For Obstruction and decreased absorption:- Ventriculo Peritoneal shunt Complication: Infection (Staph. Epid) Obstruction
  15. 32. Prognosis Depends on:- the cause for ICT the rate of increase in ICT the presence of other developmental abnormalities of brain the time at which the treatment was initiated (early or late)
  16. 33. Prognosis Abnormalities observed in long term follow- up are: Developmental disabilities Memory disturbances Visual problems strabismus, field defects, optic atrophy Accelerated pubertal development Increased Gonadotrophin levels
  17. 34. To Sum UpTo Sum Up
  18. 35. THE END


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