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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

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WILL WESTON 4 TH Year Medical Student

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  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

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