1.
HYDROCEPHALUS

2.
Definition
Hydrocephalus is a condition with abnormal
accumulation of cerebrospinal fluid in the ventricles
of the brain due to an imbalance in the production
and absorption of CSF causing ventriculomegaly
and increased intracranial pressure.
(Susamma&Anupama )
 Hydrocephalus is a condition of imbalance
between the production and absorption of CSF
(Rimple sharma)

3.
ETIOLOGY and TYPES
1. Communicating HC
No blockage in the CSF pathway, but the
absorption may be affected
2. Non communicating HC
the block is at any level of ventricular
system

4.
A. Congenital hydrocephalus
- Intrauterine infection
Rubella, CMV, Toxoplasmosis
- Congenital malformation eg.tumors,spinabifida
B. Acquired hydrocephalus
Tuberculosis, chronic and pyogenic meningitis
Post intraventricular haemorrhage, tumours,
intracranial haemorrhage

5.
Normal pathway of CSF
Lateral ventricle
(foramen of monro)
3rd ventricle
4th ventricle
Cisterna of subarachnoid space
Finally reabsorbed in to venous sinuses by
arachnoid villi

6.
Pathophysiology
Production Obstruction Reabsorption
ICP
Non-
communicating
HC
Volume of CSF
Ventricular dilation
S/S

7.
CLINICAL FEATURES
EARLY INFANCY
 Abnormally rapid head growth
 Bulging fontanelles
 Dilated scalp veins
 Separated sutures
 Macewen sign (cracked –pot sound) on
percussion
 Thinning of skull bones

8.
LATER INFANCY
1. Frontal enlargement
2. Depressed eyes
3. Setting sun sign/sunset sign (sclera
visible above the iris)
4. Pupils sluggish, with unequal response
to light

9.
CHILDHOOD
◦ Headache on awakening
◦ Papilledema
◦ Strabismus
◦ Ataxia
◦ Irritability
◦ Lethargy
◦ Apathy (lack of interest/enthusiasm)
◦ Confusion
◦ Impaired judgement and reasoning skills

10.
DIAGNOSTIC EVALUATION
 History and physical examination
 Increase in head circumference in first 3 months,
more than 1cm every 15days(suspicion of
hydrocephalus)
 CT, MRI (to reveal ventricular enlargement)
 X-ray skull
 Ultrasonography
 CSF dynamic scan
 angiography

11.
Management
 Objectives:
- Relief of hydrocephalus or reducing
ICP
- Prevention ad management of
complication
- Managing problems caused by
pathology

12.
Medical management
 For mild hydrocephalus
 Osmotic diuretics (to reduce CSF secretion)
Acetazolamide or frusemide, 50mg/kg/day
Glycerol is also used for same purpose.
 Inj. Mannitol (to reduce production& ICP)

13.
Surgical management
 OBJECTIVES :
1. Removal of the obstruction
2. Reduction in CSF production
3. Shunting of CSF from the ventricle to another
site

14.
1. Shunting
- Ventriculoperitoneal shunt(most
commonly used)
- Ventriculoatrial shunt
- Ventriculopleural shunt
- Ventriculoureteric shunt

15.
COMPLICATIONS
 Shunt block at ventricular or peritoneal
end
due to cell debris
 Malposition of ventricular end
 Displacement of shunt tube
 Psuedocyst in the abdomen
 Shunt infection: Septicemia, wound
infection,
 meningitis, ventriculitis, peritonitis.
 Seizures
 Acute subdural hygroma

16.
Nursing management
1. Preoperative nursing care
- Daily measure HC
- Palpate fontanels for increased ICP
- Assess the pupillary response
- Monitor vital signs

17.
NURSING DIAGNOSIS
|
 Risk for injury related to increased
Intracranial pressure
 Imbalanced nutrition less than body
requirement related to poor
feeding/vomiting
 Deficit knowledge of parents regarding
the care of shunt.
 Risk for injury related to shunt
complications.

18.
Maintenance of nutrition
 Observe nutritional status of the child.
 Frequent feed with small amount.
 Serve food which the child likes.
 Hold the head in proper position
 Avoid strain on neck
 Burping
 Administer antiemetics half an hour
before feeds.

19.
Prevention of infection ad
irritation
 Change position frequently
 Place soft cotton pads or water pillow
under the head
 Keep the baby clean and dry