Posts Tagged Hydrocephalus

Hydrocephalus

Posted by on Saturday, 3 April, 2010

Hydrocephalus means an enlargement of the ventricles in the brain. This is caused by an obstruction of the flow of the cerebrospinal fluid. The fluid will build up and cause the ventricles to enlarge. If the ventricles continue to enlarge, the brain tissue will be compressed. Sometimes hydrocephalus will stop and surgery is not needed. If it does not stop on its own, a thin tube called a “shunt” is inserted through the brain into the ventricle; the other part of the tube is passed beneath the skin into the abdominal cavity. This is called a ventriculoperitoneal shunt (V-P shunt). This shunt will drain the cerebrospinal fluid, when it starts to build up, into the abdomen where it is reabsorbed. In infants, the unmistakable sign of hydrocephalus is enlargement of the head clearly disproportionate to the infant’s growth. Other characteristic changes include distended scalp veins; thin, fragile and shiny looking scalp skin; and underdeveloped neck muscles. In severe cases, the eyes are displaced downward, and the sclera is prominent (sunset eyes, setting-sun sign). A high-pitched, shrill cry; abnormal muscle tone of the legs; irritability; anorexia; and projectile vomiting often occur. The major complications of VP shunts are infection and malfunction. All shunts are subject to mechanical difficulties, such as kinking, plugging, or separation or migration of the tubing. Malfunction is most often caused by mechanical obstruction either within the ventricles from particulate matter (tissue or exudate) or at the distal end from thrombosis or displacement because of growth. The most serious complication, shunt infection, can occur at any time but the period of greatest risk is 1 to 2 months following placement. An infection is treated with massive doses of antibiotics administered by the intravenous route or directly into the ventricles via the shunt reservoir. A persistent infection requires removal of the shunt until the infection is controlled.

  1. Swelling along shunt tract.
  2. High-pitched cry.
  3. Bulging fontanels.
  4. Prominent scalp veins.
  5. Irritability when awake.
  6. Increased frontal occipital circumference.
  7. Projectile vomiting.
  8. Change in appetite.
  9. Lethargy.
  10. Lower extremity spasticity.
  11. Elevated temperature.

The infant with a shunt obstruction or infection often presents as an emergency with clinical manifestations of increased intracranial pressure, frequently accompanied by worsening neurologic status.