Hydrosefalus

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Oktatika Pratiwi
 Definition Adult Hydrocephalus
Ventricular enlargement due to altered CSF
flow or resorption, with or without symptoms
or neurologic impairment
Obstructive Hydrocephalus
Impairment of CSF flow within the ventricular system
Communicating Hydrocephalus
Impairment of CSF flow or resorption outside the ventricular
system
Impaired flow to the venous system
Over production CSF
Impaired resorption at the arachnoid granulations

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 Anatomy
2 ventricle lateral 1st and 2nd
2 ventricle midline 3rd and 4th
Interventricular foramen
Cerebral Aqueductus
2 lateral aperture and 1 median aperture
Subarachnoid space

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Anatomy

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Anatomy

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 Function
Providing a cushion
Prevents the weight of the brain from
compressing the cranial nerve roots and
blood vessels

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 Epidemiology

M.A. Williams Support for ICD-9 Code for NPH 7

 Obstructive Hydrocephalus:
Aqueductal Stenosis
Interventricular
Foramen monroe
Cereberal
Aqueductus

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Communicating Hydrocephalus
Idiopathic
In the elderly, normal pressure
hydrocephalus
Chronic
Symptomatic (secondary) hydrocephalus
Post-subarachnoid hemorrhage (aneurysm),
post-infectious, post-traumatic Arachnoid
granule or venous obstruction
Acute, subacute or chronic onset
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 Etiology
Congenital causes in infants and children
Agenesis of the foramen of Monro
Congenital toxoplasmosis
Brainstem malformation causing stenosis
of the aqueduct of Sylvius
Bickers-Adams syndrome

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 Etiology
Acquired causes in infants and children
Hemorrhage
Mass lession
Hypervitaminosis A increasing BBB
permeability

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 Etiology
hydrocephalus in adults
SAH
Meningitis
Tumor
Trauma

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 Sign and Symptom
Papilledema: If raised ICP is not treated, it leads to
optic atrophy.
Failure of upward gaze and of accommodation indicates
pressure on the tectal plate.
Unsteady gait is related to truncal and limb ataxia.
Spasticity in legs also causes gait difficulty.
Large head: The head may have been large since
childhood.
Unilateral or bilateral sixth nerve palsy

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 Sign and symptom
iNPH

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Diagnostic
CT-Scan
Evans index >0,3
Sulcus medianus dilated
Hemisfer sulcus dilated

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 Diagnostic iNPH
Cysternography
CSF tap test
CT
CBF

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 Treatment
Conservative
Hyperventilation
Acetazolamid
Furosemide
Operative
VP
VA CVD
LP decubitus and lumbal stenosis
Ventricular tap
Ventriculopleura
Treatment iNPH

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Treatment probable iNPH

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 Prognostic
Herniation poor prognostic
Shunt dependence occurs in 75% of all
cases of treated hydrocephalus and in
50% of children with communicating
hydrocephalus

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Complication

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Thank you