Case Report, Sep

17th 2015

Hydrochepal
us

Thifla Farhani/ Nurul Amantillah

Dr. Bustami Sp. BS

BAGIAN/ SMF ILMU BEDAH

RSUD dr. ZAINOEL ABIDIN BANDA ACEH
2015

Introduction
A surgical disease
Most case are lethal if left
untreated
0.2-4 case from 100.000
birth in world
Surgical
intervention
(shunting) give a positive
impact for the disease
progress.

Case Report

Anamnesis
Baby boy, three months YO, came to RSUZA with
chief complain enlarged of head since birth.
VP shunt had already performed for this patient
since birth and give a positive result.
Patient has already taken the VP shunt
procedure for five times because the relaps of
head enlargement.
Enlargement of patient head still appear until
present day.

Anamnesis
Mother is already know her baby had head enlargement
since 9 month of her gestational age.
History of seizure (+), family history of head enlargement
(-)

Physical
Examination
General
findings

General contition :

Good
Consciousness : CM,
GCS : 15
HR : 160 beat/m,
regular
RR : 36 time/m
T : 36.8 0C

Local findings

Head : there was an

enlargement of head
and vein. Cracked pot
sign (+)
Eye : there
was a
sunset phenomemon.
Others in normal limit

Work Up

Laboratory
findings
Jenis
pemeriksaan
Hb
Ht
Erytrocyte
Trombin
Leukocyte
Sodium
Potassium
Chlorin
Bleeding time

July 9

th

2015

7.8gr/dL
26%
3.5 x
106/mm3
330 x 103mm
11.5 x
103mm
133 mmol/dL
3.4 mmol/dL
102 mmol/dL
2

July 27th
2015
10.4 g/dL
33%
4.3
x
106mm
334
x
103mm
13.3
x
103mm
132
mmol/dL
4,6
mmol/dL
103
mmol/dL
3

Normal
12.0-15.0
37-47
4.2-5.4
150-450
4.5-10.5
135-145
3.5-4.5
90-110

Work Up
Radiology (Thorac Xray)/july 29th
Cor and Lung in normal
limit

Abces and
subcutaneous
emphysema

Work Up
Radiology (Head CT-Scan)
Dilatation
of
lateral
ventrikel III and IV
dextra and sinistra
Expectation
:
Communicans
Hydrocephalus

Diagnose
Macrocephaly e.c
Communicans
hydrocephalus

Treatment
In hospital ward

Antibiotic agent
Antipiretic
agent
Analgetic agent
Anticonvulsant
agent

Surgical Intervention

Perfor
m
VP
shunt.

Prognosis
Quo ad Vitam : Dubia ad bonam
Quo ad Functionam : Dubia ad
malam
Quo ad Sanactionam : Dubia ad
malam

Literary

Definition
Hydrocephalus is abnormal
accumulation of CSF in brain
ventricel due impared CSF
flow, reasbsorption, or
excessive CSF production

Classification
Communicans
Hydrocephalus

Noncommunicans
Hydrocephalus

Clinical Manisfestation

Work Up
Prenatal
USG

CT-Scan

MRI

Diagnose

Treatment

Prognosis

Commonly poor.
Early
diagnose

and
treatment make a better
outcome
Late
diagnose
or
treatment
makes
permanently
neurologic
defect.
21

Discussion

Discussion
Findings

Reason

Macrocephalia

Prominen vein over the head

Cracked pot sign

Sunset sign

All of that findings comeout because the increasing of the

intracranial pressure due to abnormal accumulation CSF in
ventricular systems (obstruction or impared absorption)

Discussion
Findings

Reason

History of seizure

Siezure happens if there is some defect at brain tissue.

Siezure indicates late onset of hydrocephalus.

Siezure indicates neurology defect that made poor outcome in

future life.

Discussion
Findings

Reason

Relaps Incidence

Relaps happens if shunting is fail.

Many factors affect the failure of shunting process such as

malfunction (obstruction, overdrainage, and underdrainage), and
shunt infection.

Discussion
Findings

Reason

Relaps Incidence

Relaps happens if shunting is fail.

Many factors affect the failure of shunting process such as

malfunction (obstruction, overdrainage, and underdrainage), and
shunt infection.

Discussion
Reason

Therapy

Surgical
intervention

The
goal therapy in hydrocephalus is intraventrikuler drainage. VP shunt is one optional
therapy for hydrocephalus in pediatric patient. Performed VP shunt for surgical
medicamentose therapy
intervention because in pediatric patient peritonium cavity have bigger space that can
accomodate the lenght of shunt cateter.

Medicamentosa therapy usually use as symptomatic therapy (antibiotic for infection,

analgesic for reduce pain, antipiretic for fever, and anticonvulsant for seizure)

Thank You
Lets Discuss