Hydrocephalus

Definition
• Greece language: "hydro " which means water, and "cephalus "
meaning the head.
• Hydrocephalus is a disease that occurs due to the disruption of the
flow of fluid in the brain, it causes the fluid multiply that would
suppress the surrounding brain tissues, particularly nerve centres are
vital.
Classifications
• According to the clinical manifestations.
1. Manifest Hydrocephalus (overt hydrocephalsus)
2. Hydrocephalus that is hidden (occult hydrocephalus)
• According to the time of its formation
1. Congenital Hydrocephalus
2. Infantile Hydrocephalus
3. Hydrocephalus akuisita
• According to the process of the formation
1. Acute Hydrocephalus
2. Chronic Hydrocephalus
• According to the circulation of CSS
1. Hydrocephalus komunikans
2. Non-Hydrocephalus komunikans
• Pseudohidrosefalus
• Normal Pressure Hydrocephalus ( NPH )
Epidemiology
• The incidence of congenital hydrocephalus in the United States was
0.9 per 1,000 live births.
• Acquired hydrocephalus incident is not known with certainty for a
variety of disorders that can cause the condition.
Etiology
• Congenital
• Acquired
Risk Factors
• Born prematurely
• Problems during pregnancy ex : infections
• Problems with fetal development ex : incomplete closure of the spinal
column
• lesions and tumors of the spinal cord or brain
• Infection of the nervous system
• Bleeding in the brain
Pathophysiology
• Hydrocephalus occurs as a result of an imbalance between
production, obstruction and absorption of CSS
Pathophysiology
• CSS production overload
Cause : the khoroideus plexus Papilloma, this type of hydrocephalus
can be cured
• CSS flow obstruction
Causes : bleeding subarakhnoid post trauma or meningitis, stenosis on
aquaductus, basal sisterna, posterior fossa tumors
• CSS absorption decreases
Caused : post subarachnoid haemorrhage, post meningitis, protein CSS
is very high.
Clinical Manifestations
• In Infants
1. Head enlarged
2. Veins of the head prominen
3. The cantle Ia stretched and strained
4. Sutura widens
5. Cracked pot – sign
6. Motor development late
7. Mental development too late
8. Increased muscle tone, hiperrefleksi (knee reflex)
Clinical Manifestations
• In Children
1. When cranialis suture shut down, there was signs of a rise in
intracranial pressure
2. Projectile vomiting
3. Head pain
4. Seizures
5. Decreased consciousness
6. Papiledema
Diagnosis
• Measurement of a circle head periodically
• Examination of the cerebrospinal fluid
• Imaging
1. Tests on skull transiluminasi
2. X – photo heads
3. USG
4. CT – scan
5. MRI
Treatments
• Pharmacology
1. Acetazolamide (ACZ) : Dosis per oral 2-3 x 125 mg/day can be increased a
maximum of 1200 mg/day
2. Furosemide (FUR) : Dosis per oral 1.2 mg/kgBB 1x/day
or Intravenous injection 0.6 mg/kgBB/day
When 1 week no changes, patients are recommended operations
3. Carbonic anhydrase inhibitors
4. Acetazolamide (Diamox)
5. Loop diuretics
6. Furosemide (Lasix)
7. Antibiotics
Treatments
• Repeated lumbar pungsi
Indications: done on hydrocephalus komunikans
• Operation
Emergency patients are usually given intravenously manitol 0.5-2
g/kgBB/day time 10-30 minutes
1. “Third ventriculostomy” / Ventricle III
2. Operation shortcut / “Shunt” (most often done and most effective).
The most commonly used method is a method of Ventriculo-
Peritoneal (VP) shunt