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INFANTILE
HYDROCEPHALUSR. Faingold.
Maputo 2018
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Hydrocephalus
Definition: Increased CSF volume
Etiology:
Obstruction to CSF flow
Decreased CSF absorption (NPH)
Increased CSF production
Classification in infants:
Congenital
Acquired
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Congenital Hydrocephalus
Primary aqueductal stenosis
Dandy-Walker malformation
Chiari malformation type II
Myelomeningocele
Secondary gliosis due to intrauterine viral infections
(mumps, varicella, TORCH infections)
Arachnoid cyst (posterior fossa)
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Acquired Hydrocephalus
Post meningitis
Post hemorrhage (SAH, IVH)
Vascular malformations
Neoplastic masses
Infections
Brain abscesses
Hematoma
Venous sinus thrombosis
Choroid plexus papilloma
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Epidemiology
Most common cause of hydrocephalus: acquired aqueductal
stenosis
Obstruction by infection, hemorrhage or mass
Most common congenital cause: myelomeningocele (often with
Chiari II or aqueductal stenosis)
Congenital hydrocephalus 0.5-0.8 per 1000 live births (50%
due to myelomeningocele)
100 000 shunts implanted internationally every year
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Epidemiology
Incidence of acquired hydrocephalus unknown
Congenital aqueductal stenosis: 10% hydrocephalus of the
newbown
Dandy-Walker: 2-4%
Mass lesion: 20% of all hydrocephalus in children
In developing countries: congenital and infectious
In developed countries: congenital, post- hemorrhagic,
infectious
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Clinical Manifestations in Infants
Accelerated rate of enlargement of the head
Bulging anterior fontanelles
Widening of cranial sutures
Upper motor neuron signs (brisk reflexes)
Irritability, lethargy, poor feeding
Sunset sign (forced downward deviation of eyes)
Episodic apnea and bradycardia
Signs of Increased ICP
Lethargy, vomiting, headache
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Imaging Options
U/S
CT
MRI
ICP monitoring
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Pattern of Dilatation
Stenosis of aqueduct
Dilated lateral and
third ventricle
Normal size fourth
ventricle
Communicating
hydrocephalus
Symmetrical dilatation
of the ventricles
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Suggestive of Hydrocephalus:
Enlargement of the recesses of the 3rd ventricle
Dilatation of the temporal horns of the lateral
ventricles
Interstitial edema of periventricular tissue
Effacement of cortical sulci
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Benign Enlargement of
Subarachnoid Spaces in Infants
Transient developmental
phenomenon
Most are self-limiting
Up to 16% of infants
Macrocephaly
Prominence of SAS
Mild ventricular enlargement
Typically 2-7 months
When hydrocephalus is present
= EVOH (extra-ventricular
obstructive hydrocephalus
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Increased extra-axial spaces
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Increased subarachnoid space seen on ultrasound
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Increased extra-axial spaces with dilated ventricles
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Grade IV IVH + hydrocephalus
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THANK YOU!
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References
Hydrocephalus. UpToDate Inc. Last updated April 5 2012. Viewed July 18 2012.
http://www.uptodate.com/contents/hydrocephalus?source=search_result&search=hydrocephalus&selectedTi
tle=1~150#H434050
Barcovich J. Hydrocephalus. In: Diagnostic Imaging – Pediatric Neuroradiology. 1st Edition Salt Lake City,
Utah, Amirsys Inc. 2007. pp I-15 (14-17).
http://www.mrcophth.com/MRCOphth/mrcophthpartoneessay/vent.gif
Adeloye A. Management of infantile hydrocephalus in Central Africa. Trop Doct. 2001Apr;31 (2): 67-70
Etiology and evaluation of macrocephaly in infants and children. UpToDate Inc. Last updated October3
2011. Viewed July 18 2012. http://www.uptodate.com/contents/etiology-and-evaluation-of-
macrocephaly-in-infants-and-
children?source=search_result&search=benign+enlargement+of+subarachnoid+spaces+in+infancy&select
edTitle=1~150#H12
Hydrocephalus. MedScape. Last updated November 4 2011. Viewed July 18 2012.
http://emedicine.medscape.com/article/1135286-clinical#a0218