WILL WESTON

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HYDROCEPHALUS IN CHILDHOOD

• WILL WESTON
• 4TH Year Medical Student

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BOBBY 6 Year ?
MOTHERS PAST OBS HX

• 1989 10 Year Old Girl (Term NVD)
• 1991 8 Year Old Boy (Term NVD)
• 1993 6 Year Old Boy (Term NVD)

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PREGNANCY LABOUR

• Normal Pregnancyup until 334 / 40
• CTG Fetal Distress (tachycardia)
• ?
• ARM Syntocinon
• ?
• Vaginal Delivery

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AFTER LABOUR

• APGAR 9 _at_ 1 min 9 _at_ 5 mins.
• ECG Supraventricular Extrasystole ? SCBU
• Imaging
• Interuterine Fetal Intercranial bleeding
• (subarachnoid interventricular haemorrhages)
• ?
• Hydrocephalus
• ?
• VP Shunt (10/3/00aged 4/12)

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HYDROCEPHALUS- DEF
Disturbance of FORMATION / FLOW /ABSORPTION of
CSF ? ? Volume occupied in the CNS.
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HYDROCEPHALUS- DEF
Disturbance of FORMATION / FLOW /ABSORPTION of
CSF ? ? Volume occupied in the CNS.
FORMATION FLOW (indirectly inhibits
absorption) ABSORPTION
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CAUSES

• CONGENITAL CAUSES IN INFANTS AND CHILDREN
• Stenoses of aqueduct of Sylvius due to
  malformation (10)
• Others
• Dandy-Walker malformation
• Arnold-Chiari malformation type 1 and type 2
• Agenesis of the foramen of Monro
• Congenital toxoplasmosis
• Bickers-Adams syndrome

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CAUSES

• ACQUIRED CAUSES IN INFANTS AND CHILDREN
• Mass lesions 20
• Intraventricular haemorrhage
• Infections Meningitis (especially bacterial).
• Increased venous sinus pressure
• Iatrogenic E.g. Hypervitaminosis A
• Idiopathic

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SYMPTOMS in Infants

• Poor feeding Activity
• Irritability Vomiting

SIGNS in Infants

• Head enlargement
• Dysjunction of sutures Tense fontanelle
• Dilated scalp veins
• Setting-sun sign Characteristic in infants of ?
  ICP.
• Increased limb tone

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SYMPTOMS in Children

• Slowing of mental capacity
• Headaches, Vomiting Drowsiness
• Neck pain
• Blurred vision
• Double vision
• Difficulty in walking

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SIGNS in Children

• Papilledema

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SIGNS in Children

• Papilledema
• Failure of upward gaze
• Macewen sign "cracked pot
• Unsteady gait
• Large head
• Unilateral / bilateral 6th nerve palsy

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INVESTIGATIONS

• ULTRASOUND (Evaluates intraventricular
  haemorrhage)
• SKULL X RAY
• CT / MRI

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INVESTIGATIONS

• ULTRASOUND (Evaluates intraventricular
  haemorrhage)
• SKULL X RAY
• CT / MRI

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MANAGEMENT- MEDICAL

• Used to delay surgical intervention.
• May be tried in premature infants with
  posthemorrhagic hydrocephalus.
• ? CSF Secretion by choroid plexus
• Acetazolamide Furosemide
• ? CSF Reabsorption
• Isosorbide (effectiveness is questionable)

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MANAGEMENT- Sx (SHUNT)

• Establish communication between CSF and drainage
  cavity.

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• VENTRICULO-PERITONEAL (VP).
• Lateral ventricle ? Peritoneum.
• Advantage No need to lengthen catheter with
  growth.
• VENTRICULO-ATRIAL (VA)
• Cerebral ventricles ? Jugular Vein ? SVC ? RA.
• Used when patient has abdominal abnormalities
• Others
• Lumboperitoneal / Torkildsen / Ventriculopleural.

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MANAGEMENT- Sx (Others)

• Ventricular tap
• Open ventricular drainage
• LP in Posthemorrhagic Postmeningitic
  hydrocephalus.

PROGNOSIS

• Long-term outcome related directly to cause of
  hydrocephalus.
• Up to 50 with large intraventricular
  haemorrhage ? Permanent hydrocephalus requiring
  shunt.

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SINCE LABOUR

• Drug Hx
• No Known Allergies
• All Relevant Immunisations
• Movicol Constipation
• PMHx
• Occasional blocking of shunt, but currently
  satisfactory.
• Aspergers Syndrome (Special Ed at mainstream
  school)
• Headaches
• Trance like episodes

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TRANCE LIKE EPISODES

• Timing
• Occur in clusters (weeks - months apart) gt often
  at school.
• Frequency of Clusters 2-3 / Episodes a week.
• Duration of each episode lasting secs mins.
• Observations
• Staring blankly
• Tachypnoea
• Lasting

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MANAGEMENT PLAN

• School Diary
• Video Footage Parents Teachers Mobile Phones
• EEG
• Mental retardation, Cerebral palsy and EPILEPSY
  are known to be related to infantile
  hydrocephalus1,2
• Persson EK, Hagberg G, Uvebrant P. Hydrocephalus
  prevalence and outcome in a population-based
  cohort of children born in 1989-1998. Acta
  Pædiatrica 2005 Jun94(6)726-32.
• Battaglia D et al. Epilepsy in shunted
  posthemorrhagic infantile hydrocephalus owing to
  pre- or perinatal intra- or periventricular
  hemorrhage. J Child Neurol. 2005 Mar 20
  (3)219-25.

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Any Questions