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Hydrocephalus in Pediatrics

Author:

Arshika Singh is an Child Health Nurse, has completed her masters from CMC, Ludhiana.

Anatomy of Brain and Its Ventricles

Definition of Hydrocephalus

Hydrocephalus as per the word "Hydro" means water and the term can be defined as water in brain.

In Pediatrics, Hydrocephalus is a very common term which occurs due to increased production of cerebrospinal Fluid like in tumor, alterations in absorption of CSF or due to obstruction in flow of CSF. Basically, its an imbalance between the production and absorption of cerebro-spinal fluid.

Flow of cerebro - spinal fluid in brain and spinal cord

Description of CSF

Cerebro- spinal fluid is produced by choroid plexus of brain lateral ventricles. It is being produced at rate of 20 - 25 ml/hour. It is clear, odorless fluid.

Etiology of Hydrocephalus

Types of Hydrocephalus in Paediatrics

Types of Hydrocephalus

Sunset Eyes in infant

Clinical Manifestations of Hydrocephalus in Infants

  • Bulging Fontanel
    • a rapid increase in head circumference
    • Sunset Eyes.
    • seizures
    • extreme fussiness
    • vomiting
    • excessive sleepiness
    • poor feeding
    • low muscle tone and strength

Bulging fontanel in Infants

Toddler and young Children

  • short and high-pitched cries
  • personality changes
  • distorted facial structure
  • headache
  • delayed milestones
  • extreme sleepiness
  • irritability
  • loss of muscle coordination
  • loss of bladder control
  • larger than normal head
  • vomiting and nausea
  • seizures

Diagnostic Procedures for Hydrocephalus

  • In Prenatal Phase - Ultrasonically - In this diagnostic procedure, sound waves are used to create an image of an internal portion of the body and it can also be used to determine the size of the ventricles in the womb.
  • Physical Examination - Head to Toe - increase in Head circumference, delay in milestones are being assessed.
  • Ultrasonically of fontanels,
  • CT scan - This procedure is being used to produce detailed image of ventricular system of brain and to identify the structural issues.
  • MRI

Treatment Plan for Hydrocephalus

  • Ventriculo - Peritoneal Shunt - With the creation of Burr hole, shunt is created from brain ventricles to the peritoneal cavity of gastro - intestinal tract. The increased CSF is shunted in peritoneal cavity and then is absorbed in the circulation. This is most commonly used treatment strategy.

Ventriculo - Peritoneal Shunt

Ventriculo - Atrial Shunt

This shunt mechanism can also be used in hydrocephalus, but it is used rarely. This this the shunt is being created from the ventricles of the brain to the Atria of Heart, where excessive CSF is shunted out and absorbed in circulatory system.

VA shunt

Ventriculo- Pleural Shunt

Ventriculo - Pleural shunting is an alternative option for the shunting of excessive produced CSF into the Plueral Layer of Lungs. In this technique, the distal catheter is placed in the pleural space.

Follow Up after Surgery

Neurological functions will be evaluated after surgery and if any problem persist, rehabilitation and problem solving approach is practice to provide the quality of life to the child.

In case of following symptoms if present, physician should be contacted on urgent basis -

  • Redness, tenderness, pain or swelling on the site of incision.
  • Irritability,or drowsiness
  • Nausea, vomiting, headache
  • Fever
  • Abdominal pain
  • Return of preoperative neurological symptoms like headache, increase in head circumference, sunset eyes.


Prognosis

The prognosis for the hydrocephalus largely depends on the cause, the extent of symptoms and the timeliness of diagnosis and treatment. Some children show a dramatic improvement with treatment.

Shunt malfunction or failure on greater chances may occur. The valve may be clogged or the pressure of the shunt may not be adequate enough to match the needs of the patient. In cases of infection, antibiotic therapy is needed and likely to have temporary removal of the shunt and replacement by a drain till the infection clears. A shunt malfunction may be indicated by headaches, vision problems, irritability, fatigue, personality change, loss of coordination, difficulty in waking up or staying awake, a return of walking difficulties, mild dementia or incontinence.

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2021 Anu

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