1. HYDROCEPHALUS
SUBMITTED BY:SAKSHI SRIVASTAVA
MSC NSG FINAL YEAR
JINSAR

2. HYDROCEPHALUS

3. HYDROCEPHALUS
The term Hydrocephalus comes
from the two Greek words:
'hydro' which means water, and
'cephalus' which means head. In
years past, it was commonly
called 'water on the brain'. Put
simply it is a condition where
there is too much cerebrospinal
fluid in the cranium

4. The balance between production
and absorption of CSF is
critically important. Ideally, the
fluid is almost completely
absorbed into the bloodstream as
it circulates; however, there are
circumstances which, when
present, will prevent or disturb
the production or absorption of
CSF, or which will inhibit its
normal flow. When this balance is
disturbed, hydrocephalus is the

5.  ANATOMY AND PHYSIOLOGY OF
CEREBROSPINAL FLUID
 Cerebrospinal fluid (CSF) is found
within the brain and the spinal cord.
It is a clear, watery substance that
flows through a channel into the
space (subarachnoid space) around
the brain and spinal cord, where it
also functions as a cushion. The
CSF is absorbed back into the
bloodstream via mushroom-like
structures over the brain

6.  A small amount of CSF is
produced by the spinal
cord. The CSF contains
nutrients and proteins
necessary for the
nourishment and function
of the brain and carries
waste products away from
tissues in and around the

7. The fluid is produced within
hollow channels in the brain
called ventricles, primarily
within the lateral ventricle. In
each ventricle is a specialized
structure (which looks like
small flower-like tufts) called
the choroid plexus, which is
responsible for the majority of
CSF production

9. Congenital Hydrocephalus
This means that Hydrocephalus is
present at birth. It is important
to remember that this
term does not imply that it is
hereditary. Often the exact
cause of Congenital
Hydrocephalus cannot be
determined but known causes can
include:

10. Aqueductal Stenosis (noncommunicating)
The most common cause of
congenital Hydrocephalus is an
obstruction called aqueductal
stenosis. When the
long, narrow passageway
between the third and fourth
ventricles (see
‘What is Hydrocephalus’
diagram) is narrowed or
blocked, perhaps because of
infection,
haemorrhage or a tumour.
Fluid accumulates "upstream"
from the
obstruction, producing
Hydrocephalus

11.  Neural Tube Defect or
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NTD (communicating)
An open NTD, where the
spinal cord is exposed at
birth and is often leaking
CSF, is often
referred to as Spina Bifida
(see ‘What is Spina
Bifida’). This kind of NTD
causes part of
the cerebellum and the
fourth ventricle to push
downward through the
opening at the base
of the skull into the spinal
cord area, blocking CSF's
flow out of the fourth

12. Arachnoid Cysts (noncommunicating)
Arachnoids' Cysts may occur
anywhere in the brain. In
children, they're often
located at
the back of the brain and in
the area of the third
ventricle. These cysts are
filled with CSF
and lined with the arachnoid
membrane. Some arachnoid
cysts are self-contained,
while
others are connected with the
ventricles or the
subarachnoid space. The
fluid trapped by
the cysts may block the CSF
pathways, producing

13. Acquired
Hydrocephalus
This means that
Hydrocephalus has
occurred after birth
and can be caused
by:

14. Intraventricular
Hemorrhage
(communicating)
An intraventricular
haemorrhage, which
most frequently affects
premature newborns,
may cause an acquired
form of Hydrocephalus.
When small blood vessels
alongside the
ventricular lining rupture,
blood may block or scar
the ventricles or plug
the arachnoid
villi. The arachnoid villi is
located in the second
layer covering the brain
which allows
CSF to be absorbed. When
the CSF can't be
absorbed, Hydrocephalus
results.

15.  Meningitis
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(communicating)
Meningitis is an
inflammation of the
membranes of the brain
and spinal cord. Caused
by
a bacterial or (less
frequently) viral
infection, meningitis can
scar the delicate
membranes(meninges)
that line the CSF
pathway. An acquired
form of Hydrocephalus
may develop if this
scarring obstructs the
flow of CSF as it passes
through the narrow
ventricles or over the
surfaces of the brain in
the subarachnoid space.

16. Head Injury
(communicating)
A head injury can
damage the brain's
tissues, nerves, or
blood vessels. Blood
from
ruptured vessels may
enter the CSF
pathway, causing
inflammation. Sites of
CSF
absorption might then
be blocked by scarred
membranes (meninges)
or by blood cells.
The CSF flow is
restricted and
Hydrocephalus

17. Brain Tumours (noncommunicating)
In children, brain
tumors’ most commonly
occur in the back of
the brain (posterior
fossa). As a tumour
grows, it may fill or
compress the fourth
ventricle, blocking the
flow
of CSF and causing
Hydrocephalus. A
tumors somewhere else
in the brain might also
block or compress the
ventricular system

18. Ventriculitis
(noncommunicating)
Ventriculitis is a
disease causing
inflammation and
or infection of
the ventricles. It
is
most common in
infants and is

19. CLINICAL MANIFESTATION:
The signs and symptoms of
hydrocephalus vary generally by
age of onset:
Infants
Common signs and symptoms of
hydrocephalus in infants include:
 An unusually large head
 A rapid increase in the size of
the head

20.  A bulging or tense soft spot
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(fontanel) on the top of the head
Vomiting
Sleepiness
Irritability
Poor feeding
Seizures
Eyes fixed downward (sunsetting
of the eyes)
Deficits in muscle tone and
strength, responsiveness to touch,
and expected growth

21. Toddlers and older children
Among toddlers and older children,
signs and symptoms may include:
 Abnormal enlargement of a
toddler's head
 Headache
 Nausea or vomiting
 Fever
 Delays in walking or talking
 Problems with previously acquired
skills, such as walking or talking
 Blurred or double vision
 Unstable balance

22. 
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Poor coordination
Irritability
Change in personality
Problems with attention
Decline in school performance
Poor appetite
Seizures
Sleepiness
Difficulty remaining awake or
waking up

23. Young and middle-aged adults
Common signs and symptoms in this
age group include:
Headache
Difficulty in remaining awake or waking
up
Loss of coordination or balance
Loss of bladder control or a frequent
urge to urinate
Impaired vision
Decline in memory, concentration and
other thinking skills that may affect
job performance.

24. DIAGNOSTIC EVALUATION:
Hydrocephalus is diagnosed through
clinical neurological evaluation and by
using cranial imaging techniques such
as ultrasonography, computed
tomography (CT), magnetic resonance
imaging (MRI), or pressuremonitoring techniques. A physician
selects the appropriate diagnostic
tool based on an individual's age,
clinical presentation, and the
presence of known or suspected
abnormalities of the brain or spinal

25. MANAGEMENT:
management for
hydrocephalus includes 3
way
 Medical management
 Surgical management
 Nursing management

26.  Medical treatment is not effective in
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long-term treatment of chronic
hydrocephalus. It may induce metabolic
consequences and thus should be used
only as a temporizing measure.
Medications affect CSF dynamics by
the following mechanisms:
diuretics:acetazolamide po,iv decrease
production of csf if progress of
disease is slow
anticonvulsants:Phenobarbital prevents
seizures
antibiotics:to prevent the shunt
infection such as septicemia and
meningitis.

27. SURGICAL MANAGEMENT:
Hydrocephalus is most often
treated by surgically inserting
a shunt system. This system
diverts the flow of CSF from
the CNS to another area of
the body where it can be
absorbed as part of the
normal circulatory process

28. VARIOUS TYPES OF
SHUNT PROCEDURE
 Ventriculoperitoneal shunt (VP
shunt)
 Ventriculopleural shunt (VPL
shunt)
 Ventriculoatrial shunt (VA shunt)
 Lumboperitoneal shunt (LP shunt)

29. A shunt is a flexible but
sturdy plastic tube. A shunt system
consists of the shunt, a
catheter, and a valve. One end of
the catheter is placed within a
ventricle inside the brain or in the
CSF outside the spinal cord. The
other end of the catheter is
commonly placed within the abdominal
cavity, but may also be placed at
other sites in the body such as a
chamber of the heart or areas
around the lung where the CSF can

31. Teach home care
Encourage the child to participate in
age-appropriate activities as tolerated.
Encourage the parents to provide as
normal lifestyle as possible. Remind both
the child and parents that contact sports
are prohibited.
Explain how to recognize signs and
symptoms of increased ICP. Subtle signs
include changes in school performance,
intermittent headache, and mild behavior
changes.
Arrange for the child to have frequent
developmental screenings and routine
medical checkups.

32. conclusion:
The outlook for the hydrocephalic
patient has changed dramatically
over the past three decades as
physicians caring for them have
devoted themselves not only to
developing innovative surgical
techniques and improved
hardware, but also to seeking a
normal life-style for their
patients.