HYDROCEPHALUS

HYDROCEPHALUS
• Condition caused by an imbalance in the production and absorption of CSF in the ventricular
system.
• When production is greater than absorption, CSF accumulates within the ventricular system, usually
under increased pressure, producing dilation of the ventricles.

PATHOPHYSIOLOGY
• Congenital – Abnormal development at birth – premature are at increased risk
• Acquired – Tumor, infection, hemorrhage
• Impaired absorption of CSF within the subarachnoid space (communicating hydrocephalous)
o Obstruction flow is most common in adults
• Obstruction to the flow of CSF through the ventricular system
o Noncommunicating hydrocephalous

CLINICAL MANIFESTATIONS
• Infants
o Rapid head growth, bulging fontanels, separated sutures, “setting sun” sign
• Later
o Irritability, lethargy, change in LOC
• Childhood
o Headache on awakening, papilledema, ataxia, irritability, lethargy
• Adult >60
o Wet, wobble, weird (incontinent, problem with gait, behavior change)

DIAGNOSTIC TESTS
• Infants Head circumference
• CT Scan
• MRI: Enlarge ventricle – Children should be sedated

SURGICAL MANAGEMENT
• Direct removal of obstruction (tumor) by a crainotomy
• Ventriculoperitoneal Shunt
o Placed in ventricle to drain fluid away. Control but not a cure
o Problem with infection – Massive antibiotics
o If kinked, may have headache
• Endoscopic third ventriculostomy
o Small hole on the floor of ventricles allows fluids to drain / bypass obstruction
• ½ of children with this usually have a neurological deficit

NURSING MANAGEMENT
• CP: Increased ICP
• Routine craniotomy care
o Position dictated by surgeon
o Observe for infection
o Abdominal distention
• Knowledge deficit-Family education
o Infection
o Deficits