Odstrution in the ventricular system or at the outlets d fourth ventricle Low, normal or intermilttently raised pressure

used In hydrocephalus Communicating hydrocephalus Para ventricular enlargement with communication between the ventricles and subarachnoid space. Non-comunicating or obtstructive hydrncaphalus. Odstrution in the ventricular system or at the outlets d fourth ventricle Low, normal or intermilttently raised pressure hydrocephalus Chronic hiydrocaphalus.2. either communicating or non- communicating, presenting wtih gate dsturbance, showing of mentation/dementia and urinary Incontinence (.Hakim's triad). Aiiasled hytocephahs; Apparanlly stable vanlrtculomagaJy despite a nonJuncTlorung shun! and with no appafsni neurological sequelae, but deierlorallon and even daaih may occur unpredtelably. EKiema! hydrocflphalua Self-Ming absorption •'*-,'\-~ -,r-~,- of nlancy and early childhood with rased pressure, enlarged sub arachnoid space and Inslgnllicanr enlargement o) ventricles, thecondiHon usually resolves wfthin .1. year. Causes ol hydrocephafus ObstrucilonioCSFllowwflhln Ihe ventricles Congenital Aqueduct stenosis, forking or atresia Dandy-Walker syndrome (atrasia ol lorarmna of Luschka and Magende) Hind brain abnormalities, splna btfida Vein ol Galen aneurysrn Space-occupying lesions: Acquired aquedud sienosls Colloid and arachnoid cysts. ThalamC gliorna Intravantricular lurrcurs Poaierlor fossa rumours aritrKular haemorrhage PremaluriEy A-V malforrnalion 2. Delecla ol flow -in subarachnoid space. [teplDmaningaal inllainmalion) Infections Pyogenic Tutrarculous, fungal Haemorrtiage Sufcarashnoid haemcirrViage Trauma Menlnghs carcinomarose 3. Defects of absorpilon of CSF ai The arachnoid granufallons Congonltal dellciancy of arachnoid granulalinns (uncommon).. Clinical manifestations; (11 Inlanis with rrild or severe head enlargement af birth - who subsequently exhlbfc progressive hydrocephalus due lo congenital n-Falfonrelion. (2). Infanls bom with normal head circurrfererce • who develop abnormally rapid growth of the head hydrocephalus develops 2 or 3 months layer. Due lo milder lorrns of congenllal malformailons, sequelae ol menlngifls and binh trauma, particularly Inlravantrtsulat haemorrhage Inlha premature. (3) H el erogenous group - Infanls In whom hydrocephalus has resulted from postnatal inlfamrnation and haamonhaga, neoplasm, skull detarmrtiea eic. (4) Nonnal pregsurs fiy^ocephalus -Skull large. VenincJls dtated, pressure normal Signa. 1. Enfargemenr of head - Speed o! enlargemenl la ganeralty proportkonal to the elevation of the intracranlal pressure In proportion to Ihe rapid expansion of the head, the lace remains small. The downward displacement oi the orbllal plale pushes the eyeballs portion ol Ihe solera. This logeUw w.lh a marked divergent squinl and paralysis ol upward gaze givea a very characlarlslti facial eHpresBlon {"gelrmg-aun' sign). 2. Separation ol sulures - and widening and fullness of Iha amerior fonianelle. 3. Veins o! scalp-may become pronvient asarasullol increased drainage ol Ihe blood 1mm irtfracranlal strictures Through Ihe emssaiy veins to the superficial circulation. 4. Wasting - b Gonrnon with progression ol the hydrocephalus. 6. Cracked pol resonance - on percussion ol the skull. 6. Phyacal and menial developmeni -lag behind and In advanced stages deterioration ol the acquired functions lakes place. In long lasting and severe hydrccephaius. weakness and spasticliy of all etiremiiles eventually occur. Blindness may occur. In terminal stages Confcospinal signs. In lower firnbe and ataxia may ba eaily sigra. 7. Epileptc manifestalions - commonly occur in one or another stage of the dsease Diagnose -1 Radiography d skull -may reveal evidenc of raised iniracranlal pressure -ihlnning ol skull, separation of sutures, wide lontanalle. Aqueduct slenosrs may be diagnosed from the small size of ths posterior fossa and marked expansion of the vault ot tha skull Dandy-Walkar malforrnalion may be recognised by unduly prcirinent occipital region and calcification may intfcale tumour orloKoplasmosis .2. CTscan -aliowseasy andaccuraia diagnosis of hydrocephalus. Venincular enlargement is easily seen and Us extent can be assessed Possible site ol block, malfomations and thlnness of cerebral mantle can be fudged. 3. Ullrasound - is less salbfactory than CT scan. it is howevr of value In prenatal dagnoais. If Intrauaerl hydrocfiphaluQ la diagnoBstl. and soother congenital abnormality can ba otemonstrated, the baby should be delivaredbyCaesenansactirjn aasoon as there is pulmonary maiurliy. 4. MRI - Is helpful in complex cases to detine multiple congenhal lesions and anaiomy at ihe loramen magnum. Dynamic MRI can Image the pattem of pusealile CSF flow. Trealment. 1. Treatment of causa Falling this
Relief of CSF outflow obstruction. In ptawiiri non-cornrrunlcatirig hrydracephaiu& and where it assumed that tne subarachnold space remains patant. a Kansventricular. endcecopc third vantriculoalomy may ba performed, with puncture of floor of third ventricle and drainage of CSFinto the basal ceierns (b) Endoscopic management ol intraventricular cysts or large arachnoid cysts to eslaliliah lhair conrnunication with normal CSF pathways 3 Drugs - Acelazolamde 50-75 rrgrtig/fiay decreases CSF production and in conkjnciion w*the corllcosteroids or diuretics helps to control hydrocephalus in premature infants until they are