Hydrocephalus

Overview

Hydrocephalus is a condition in which excess fluid builds up in your brain. The word hydrocephalus comes from the roots hydro meaning "water" and cephalus meaning "head." The fluid that accumulates is cerebrospinal fluid (CSF), a fluid that normally surrounds your brain and spinal cord.

In hydrocephalus, too much fluid builds up, causing abnormal enlargement of the cavities in the brain (ventricles) that contain CSF. Too much CSF in the ventricles can put too much pressure on the brain, potentially damaging the brain.

You can have hydrocephalus at birth (congenital hydrocephalus) or you can develop it later (acquired hydrocephalus). Hydrocephalus occurs in about 1 in every 500 children.

The outlook for people with hydrocephalus varies depending on how soon the condition is diagnosed, whether any other disorders are present and whether treatment is successful. Left untreated, progressive hydrocephalus is, with rare exceptions, fatal


Causes


Hydrocephalus results when the flow of CSF is disrupted or when your body doesn't absorb CSF properly. CSF provides a number of important functions, including acting as a cushion to protect your brain and bringing nutrients to your brain.

Inside your brain are four ventricles. CSF flows through the ventricles by way of channels that connect one ventricle to another. Once CSF passes through the ventricles, it flows into closed spaces (cisterns) at the base of your brain. Eventually, the CSF is absorbed into your bloodstream. Keeping the production, flow and absorption of CSF in balance is important to maintaining normal pressure inside your skull.

In adults, a variation of hydrocephalus called normal-pressure hydrocephalus may occur in which the CSF pressure is normal but the reabsorption of CSF is defective. In normal-pressure hydrocephalus, the ventricles of the brain are enlarged but not under high pressure. This type of hydrocephalus is most often seen in older adults and may be the result of injury or illness, but in the majority of cases the cause is unknown.

The causes of hydrocephalus fall into two main categories:

Obstructive (noncommunicating). This type of hydrocephalus results from an obstruction within the ventricular system of the brain that prevents CSF from flowing or "communicating" within the brain, as it normally should. An obstruction can be congenital or acquired. One of the most common types of obstructive hydrocephalus is a narrowing of a channel in the brain that connects two ventricles together (aqueductal stenosis).
Nonobstructive (communicating). This type of hydrocephalus results from problems with the production or absorption of CSF. One of the most common causes is bleeding into the subarachnoid space in the brain (subarachnoid hemorrhage). Nonobstructive hydrocephalus can also be congenital or acquired.
Doctors don't completely understand the specific causes of hydrocephalus. For congenital hydrocephalus, the causes may be genetic disposition or a developmental problem. The most common developmental problems that may lead to hydrocephalus include failure of the tissue surrounding the spinal cord to close properly (spina bifida) and herniation of the brain (encephalocele). For acquired encephalitis, the cause may be a disease or condition such as encephalitis, meningitis or a brain tumor that causes blood vessels in the brain to rupture and bleed. Or the cause may be a head injury.

Paediatrics:Tetralogy Of Fallot

The four abnormalities shown on the right characterize this fairly common condition:

1. There is a ventricular septal defect.
2. There is narrowing of the valve leading to the pulmonary arteries (pulmonic stenosis)
3. The aorta "overrides" the ventricular septal defect.
4. There is thickening (hypertrophy) of the right ventricle.



There is decreased flow of blood to the lungs, as well as mixing of the blood from each side of the heart. Despite its seeming complexity, it is quite common and often can be completely repaired.


Clinical Features:

Tetralogy of Fallot is a serious heart problem because it obstructs blood from reaching the lungs. Usually, the baby will have a bluish color called cyanosis. Although this may not be very severe at first, it generally increases over time. In some babies, the obstruction is severe causing significant cyanosis and very low oxygen levels soon after birth.

Usually the child's growth and development is not significantly affected.

Some babies with tetralogy of Fallot have periods where the cyanosis becomes very severe and the baby looks very blue. The baby may be upset at the time, and may actually pass out or even have a seizure. These periods are called "tetralogy spells" or hypoxic spells. The precise cause is not known but during a spell there is very little blood flow to the lungs. Hypoxic spells are more likely to happen when the baby is a little "dry" or dehydrated and may be prevented by careful attention to hydration particularly if the baby is having problems with vomiting or diarrhea. Spells are also more likely if the baby is anemic (low blood) so if this is noted the doctor may order an iron supplement.

During a spell, the baby turns very blue even though he or she is breathing rapidly. If a spells occurs, the baby should be placed in a knee-chest position (draw the baby’s knees up to their chest and hug them close to your body), attempt to calm the baby, and call the pediatric cardiologist or pediatrician. If a baby has even one spell, surgery will need to be scheduled to try to avoid another one that could possibly result in harm to the baby. Sometimes medicine is used to relax the right ventricle and hopefully prevent additional spells while the child is awaiting surgery.

Welcome To RPCM...

1st of Disember is the day,where all of us the pioneer of the best medical student eva will start our first session on clinical posting in IPOH Hospital.50 of were assign in a group of 12 student to diffrent posting which include the Medicine,paediatric,obstretic & gynecology. I'ts going to be a tiring day everyday starting 6th of December where we start our clases and clinical posting.
Paediatrik,my posting.1st day there,its so cool.The Paediatrik team in Ipoh was so friendly.But I dont know when clinical.Hope its be the same,i'll be posted to Taiping Hospital.So..see you soon in my next adventure..........