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Functional Classification

1. Obstructive HCP Granulatio arachnoidea

2. Communicating HCP

ETIOLOGIES Congenital
Chiari type 1 Chiari type 2 Aqueductal stenosis Dandy-Walker malformation

Acquired
Post Infections : meningitis Post hemorrhagic : SAH, IVH Secondary to masses Non neoplastic : vasc malformation Neoplastic, especially tumors around aquaductus Medulloblastoma Post op cerebral tumor removal

Arrested hydrocephalus
Compensated HCP No progression or deleterious sequelae due to HCP that would require shunt Crit : near N ventricular size N head growth curve cont psychomotor development Family education : seek medical help if they develop symptoms of intracranial hypertension (headache, vomiting, ataxia, visual symptoms)

Diagnosis
TH > 2mm FH/ID > 0,5 Mickey mouse Transependymal absorption Evans ratio FH/BPD > 30% (N : 23-27%) Upward bowing corpus callosum

Signs and Symptoms


Craniofacial disproportion Irritability, poor head control Fontanelle full and bulging Enlargement scalp veins Cracked pot sound (Macewens sign) Abducens palsy Sun set phenomen (upward gaze palsy) Irregular respiration with apneic spells Splaying of cranial suture (Xray)

DIFFERENTIAL DIAGNOSIS
HCP ex vacuo (Atrophy cerebri)

Hydrancephaly

Hydrocephalus ex vacuo
- enlargement of ventricles - cerebral atrophy - usually aging - not true

Hydrancephaly
Post neurulation defect Absence of brain tissue supplied by ICA but intack by PCA Filled with CSF HCP : cortical mantel + In shunting : control head size, no reexpansion Kx : hyperirritable, no social smiling, retain primitive reflexes, seizure EEG : no cortical activity

TREATMENT
Medical Spinal taps Surgical

Medical therapy
Diuretics
As adjunct to definitive treatment or as a temporizing measure

Acetazolamide
25mg/kg/day (PO,TID) Increase until 100mg/kg/day

Furosemide
1mg/kg/day(PO,TID)

Spinal taps
Ventricular or Lumbar taps In IVH serial taps until resorption resumes When resorption does not resume ( prot > 100mg/dl), usually need shunt

Complications of shunts
Obstruction Disconnection at a junction Break Infection Hardware erosion through skin Silicone allergy Conduit for extraneural metastases

VP shunt complications
Inguinal hernia Need tom lengthen with growth Obstruction of peritoneal cath Peritonitis Hydrocele Ascites Tip migration in to scrotum Perforation of viscus Intestinal obstruction Volvulus Overshunting

Complications VA shunt
Repeated lengthening High risk of infection Septicemia Retrograde flow of blood in to ventricles Embolus Vasc complications : thrombophlebitis, perforation