hydrocephalus

definition
enlargement of the brain ventriculus as a result of an
increase in the amount of cerebrospinal fluid (CSS)
caused by an imbalance between production,
circulation and absorption. This condition can also be
called a hydrodynamic disorder
CLASSIFICATION
1. Obstructive (non-communicating) - occurs due to
blockage of circulating CSS caused by cysts, tumors,
bleeding, infection, congenital and most common
defects -> aqueductal stenosis or blockage of the
brain ducts.

2. Non-obstructive (communicating) - can be caused

by impaired CSS balance, and also by complications
after infection or hemorrhagic complications.
Hydrocephalus Etiology can be classified as:
1) Congenital - often occurs in neonates or develops
during intra-uterine.

2) Acquired - caused by subarachnoid hemorrhage,

intraventricular bleeding, trauma, infection
(meningitis), tumor, surgical complications or severe
head trauma.
ETIOLOGY
1) Congenital abnormalities:
a) Sylvius Aquaduct Stenosis
b) Spina bifida and cranium bifida - associated with Arnord-Chiari syndrome
due to the attraction of the spinal cord, with the medulla oblongata and the
lower cerebellum and covering the foramen magnum resulting in partial or
total blockage.
c) Dandy-Walker Syndrome

2) Infection - Mening attachment arises resulting in obliteration of the

subarachnoid space.

3) Neoplasm

4) Bleeding - bleeding before and after birth in the brain can cause
leptomeningenic fibrosis in the basal area of the brain, in addition to
blockages that occur due to the organization of the blood itself.
EPIDEMIOLOGY
• Congenital hydrocephalus in the US is 3 per 1,000
live births
• Acquired hydrocephalus (aquired hydrocephalus) is
not known with certainty because of the different
causes of the disease.
• In general, the incidence of hydrocephalus is the
same for both sexes
pathophysiology
excessive fluid production, increased fluid flow
resistance, increased venous sinus pressure.
increased intracranial pressure in an effort to
maintain the balance of secretion and absorption
DIAGNOSIS

1) Funduscopic examination

2) Plain head lateral photo - enlarged head appearance

with craniofacial disproportion, thinning bone and
dilated sutura.

3) Examination of cerebrospinal fluid

4) CT scan of the head

5) MRI - can give ventricular dilatation or mass lesions

Ct scan
MRI
treatment
1) Medical conservative therapy

efforts to reduce fluid secretion and choroid plexus (asetazolamite 100 mg / kgBW
/ day; furosemide 1.2 mg / kgBW / day) or attempt to increase its resorption
(isorbid).
The above therapy is only temporary before definitive therapy

2) Ventriculoperitoneal shunting

In ventriculoperitoneal (VP) shunting, a tube is inserted through a small hole in the

skull into the space (ventricle) of the brain containing cerebrospinal fluid (CSF).
This tube is connected to another tube that runs under the skin to the abdomen,
where it enters the abdominal cavity (peritoneal cavity).
Shunt allows CSS to flow out of the ventricle and into the abdominal cavity where
it is absorbed. Usually, valves in the system help regulate fluid flow.