Hydrocephalus in Children

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Hydrocephalus in Children Leslie Acakpo-Satchivi, MD-PhD, Neurosurgery www.SpringfieldClinic.com

description

As a parent, nothing is more frightening than a sick child. When that sickness involves the brain, it becomes terrifying. It is estimated that 1 in 500 children will be diagnosed with hydrocephalus, a condition causing excessive fluid around the brain and spinal cord. Whether your child was born with hydrocephalus or developed it later, please join Dr. Leslie Satchivi as he discusses this condition, how to treat it and what it means for your child developmentally.

Transcript of Hydrocephalus in Children

Page 1: Hydrocephalus in Children

Hydrocephalus in ChildrenLeslie Acakpo-Satchivi, MD-PhD, Neurosurgery

www.SpringfieldClinic.comwww.SpringfieldClinic.com

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What is Hydrocephalus

• “Water on the Brain”

• CSF constantly produced and absorbed

• Caused by lack of absorption

• Results in increased fluid pressure in brain

• Can be present at birth or later in life

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Function of CSF

• Maintenance of a constant external environment for neurons and glia

• Mechanical cushion to protect the brain and provide buoyancy to the heavy brain (1400 g)

• Serves as a lymphatic system and a conduit for neuropeptides

• pH of CSF regulates pulmonary ventilation and CBF

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Causes

• Congenital

• Acquired– Prematurity– Infection– Tumor– Bleeding in brain– Trauma

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Signs and Symptoms

• In Young Children– Abnormal increase in head size– Irritability– Sleepiness– Vomiting– “Sunset” eyes

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Signs and Symptoms

• In older Children– Headache– Poor school performance– Loss of coordination and difficulty walking– Sleepiness– Vomiting– Loss of bladder control

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Treatment Goals

• To restore normal pressure in head– 1. restoring normal CSF flow– 2. divert CSF to another part of body

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From Anatomography website maintained by Life Science Databases(LSDB)

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Ventricular Anatomy

From: Gray’s anatomy

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Causes of OBSTRUCTIVE Hydrocephalus

• Congenital Malformations– Aqueductal Stenosis– Arachnoid Cysts

• Acute Post-hemorrhagic

• Mass lesion

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Causes of COMMUNICATINGHydrocephalus

•Defective absorption of CSF– Chronic Post-hemorrhagic– Chronic Post-Infectious

•Venous drainage insufficiency

•Overproduction of CSF (RARE)

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Normal Head CT

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Hydrocephalus

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Aqueductal Stenosis

• Obstructive hydrocephalus

• Most common cause of congenital HCP (43%)

• Asymptomatic at early age

• OFC increase

• May present later with headaches

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Endoscopic3rd

Ventriculostomy

(ETV)

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Before 14 months After

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Ventriculoperitoneal (VP)Shunt

Journal of NeurosurgeryPediatrics

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Mayo Foundation for Medical Education and Research

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Shunt Survival

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Signs & Symptoms of Shunt Malfunction

• Same as hydrocephalus

• But also signs of infection– Fever– Swelling– Redness– Drainage

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Preventative Medicine

• Education• Routine Clinic Follow-up• Surveillance Imaging– Ultrasound– CT scan– MRI

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Hydrocephalus in Premature Infants

• VP Shunting is poor option due to:– Small size– Abdomen is poor terminus– Blood in ventricles causes shunt malfunction

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Germinal Matrix Hemorrhage

•Grade 1: Hemorrhage confined to the germinal matrix

•Grade 2: Extension into the ventricle but w/o hydrocephalus

•Grade 3: Ventricular Extension with Hydrocephalus

•Grade 4: Parenchymal hemorrhage

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Subgaleal Shunt

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External Hydrocephalus

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Post-Infectious Hydrocephalus

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ARACHNOID CYST

• 14 month-old

• Inappropriate head size increase

• Unable to walk

• Abnormal reflexes

• No irritability

• No vomiting

• No excessive somnolence

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PRE-OP 6 MONTHS POST-OP

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Prognosis

• 6 in 10 will die if untreated– Survivors left with neurologic deficits

• Prompt treatment

• Prognosis dependent on cause of Hydrocephalus:– Infection/ Trauma / Tumors– Aqueductal Stenosis/ Arachnoid cyst

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Questions?