1 / 24

WILL WESTON 4 TH Year Medical Student

HYDROCEPHALUS IN CHILDHOOD. WILL WESTON 4 TH Year Medical Student. BOBBY: 6 Year ♂. MOTHER’S PAST OBS HX…. 1989: 10 Year Old Girl (Term + NVD) 1991: 8 Year Old Boy (Term + NVD) 1993: 6 Year Old Boy (Term + NVD). PREGNANCY & LABOUR…. Normal Pregnancy…up until… 33+4 / 40

Leo
Download Presentation

WILL WESTON 4 TH Year Medical Student

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. HYDROCEPHALUS IN CHILDHOOD WILL WESTON 4TH Year Medical Student

  2. BOBBY: 6 Year ♂ MOTHER’S PAST OBS HX… • 1989: 10 Year Old Girl (Term + NVD) • 1991: 8 Year Old Boy (Term + NVD) • 1993: 6 Year Old Boy (Term + NVD)

  3. PREGNANCY & LABOUR… Normal Pregnancy…up until… 33+4 / 40 …CTG: Fetal Distress (tachycardia)  ARM + Syntocinon  Vaginal Delivery

  4. AFTER LABOUR… • APGAR: 9 @ 1 min; 9 @ 5 mins. • ECG: Supraventricular Extrasystole  SCBU • Imaging: … Interuterine Fetal Intercranial bleeding (subarachnoid & interventricular haemorrhages)  Hydrocephalus  VP Shunt (10/3/00…aged 4/12)

  5. HYDROCEPHALUS- DEF: Disturbance of …FORMATION / FLOW /ABSORPTION … of CSF   Volume occupied in the CNS.

  6. HYDROCEPHALUS- DEF: Disturbance of …FORMATION / FLOW /ABSORPTION … of CSF   Volume occupied in the CNS. FORMATION FLOW (indirectly inhibits absorption) ABSORPTION

  7. CAUSES: CONGENITAL CAUSES IN INFANTS AND CHILDREN: • Stenoses of aqueduct of Sylvius due to malformation (10%): • Others: • Dandy-Walker malformation • Arnold-Chiari malformation type 1 and type 2 • Agenesis of the foramen of Monro • Congenital toxoplasmosis • Bickers-Adams syndrome:

  8. CAUSES: ACQUIRED CAUSES IN INFANTS AND CHILDREN • Mass lesions: 20% • Intraventricular haemorrhage • Infections: Meningitis (especially bacterial). • Increased venous sinus pressure • Iatrogenic: E.g. Hypervitaminosis A • Idiopathic

  9. SYMPTOMS… in Infants: • Poor feeding & Activity • Irritability & Vomiting SIGNS… in Infants: • Head enlargement • Dysjunction of sutures & Tense fontanelle • Dilated scalp veins • Setting-sun sign: Characteristic in infants of  ICP. • Increased limb tone

  10. SYMPTOMS… in Children: • Slowing of mental capacity • Headaches, Vomiting & Drowsiness • Neck pain • Blurred vision • Double vision • Difficulty in walking

  11. SIGNS… in Children: • Papilledema

  12. SIGNS… in Children: • Papilledema • Failure of upward gaze • Macewen sign: "cracked pot“ • Unsteady gait • Large head • Unilateral / bilateral 6th nerve palsy

  13. INVESTIGATIONS: • ULTRASOUND (Evaluates intraventricular haemorrhage) • SKULL X RAY: • CT / MRI

  14. INVESTIGATIONS: • ULTRASOUND (Evaluates intraventricular haemorrhage) • SKULL X RAY: • CT / MRI

  15. MANAGEMENT- MEDICAL: • Used to delay surgical intervention. • May be tried in premature infants with posthemorrhagic hydrocephalus. •  CSF Secretion by choroid plexus • Acetazolamide & Furosemide •  CSF Reabsorption • Isosorbide (effectiveness is questionable)

  16. MANAGEMENT- Sx (SHUNT): • Establish communication between CSF and drainage cavity.

  17. VENTRICULO-PERITONEAL (VP). • Lateral ventricle  Peritoneum. • Advantage: No need to lengthen catheter with growth. • VENTRICULO-ATRIAL (VA) • Cerebral ventricles  Jugular Vein  SVC  RA. • Used when patient has abdominal abnormalities • Others: • Lumboperitoneal / Torkildsen / Ventriculopleural.

  18. MANAGEMENT- Sx (Others): • Ventricular tap • Open ventricular drainage • LP in Posthemorrhagic & Postmeningitic hydrocephalus. PROGNOSIS: • Long-term outcome related directly to cause of hydrocephalus. • Up to 50% with large intraventricular haemorrhage  Permanent hydrocephalus requiring shunt.

  19. SINCE LABOUR… Drug Hx: • No Known Allergies • All Relevant Immunisations • Movicol: Constipation • PMHx: • Occasional blocking of shunt, but currently satisfactory. • Asperger’s Syndrome (Special Ed at mainstream school) • Headaches • ‘Trance like episodes’…

  20. ‘TRANCE LIKE EPISODES’… Timing: • Occur in clusters (weeks - months apart) > often at school. • Frequency of Clusters: 2-3 / Episodes a week. • Duration of each episode lasting secs – mins. Observations: • Staring blankly • Tachypnoea • Lasting

  21. MANAGEMENT PLAN… • School Diary • Video Footage: Parents & Teachers’ Mobile Phones • EEG • Mental retardation, Cerebral palsy and EPILEPSY are known to be related to infantile hydrocephalus1,2 • Persson EK, Hagberg G, Uvebrant P. Hydrocephalus prevalence and outcome in a population-based cohort of children born in 1989-1998. Acta Pædiatrica; 2005 Jun;94(6):726-32. • Battaglia D et al. Epilepsy in shunted posthemorrhagic infantile hydrocephalus owing to pre- or perinatal intra- or periventricular hemorrhage. J Child Neurol. 2005 Mar; 20 (3):219-25.

  22. Any Questions

More Related