floreine(jemimajoseph, english,forhealth,professionals ... · united’states:3cases ofcongenital...
TRANSCRIPT
Floreine-‐Jemima JOSEPH English for Health Professionals UNDH/FMSS June 2015
¡ Definition ¡ Facts and Figures ¡ Pathophysiology ¡ Clinical presentation ¡ Diagnosis ¡ Management
2
¡ Hydrocephalus § hydro = water § cephalus = head
¡ Disturbance of cerebrospinal fluid (CSF) formation, flow, or absorption,
¡ à in volume occupied by this fluid in the central nervous system (CNS)
3
¡ United States: 3 cases of congenital hydrocephalus per 1,000 live births
¡ International: About 100,000 shunts implanted each year in developed countries
https://www.flickr.com/photos/helpcurenow/11996706923 (taken 06-‐01-‐2015)
4
¡ CSF § a cushioning barrier in which the brain floats § used to carry nutrients to the brain and carry away waste products
§ mainly found in the cavities of the brain known as the ventricles
5
¡ Normal CSF production: 0.20-‐0.35 mL/min
¡ Produced by the choroid plexus located within the ventricular system
http://neurosurgery.ufl.edu/patient-‐care/diseases-‐conditions/hydrocephalus/ (taken 06-‐01-‐2015)
6
¡ Normal route of CSF § choroid plexus § lateral ventricle § foramen of Monro § third ventricle § aqueduct of Sylvius § fourth ventricle § foramina Luschka/Magendie
§ subarachnoid space § venous drainage
7
¡ Hydrocephalus if production > absorption § Overproduction of CSF ▪ Choroid tumor
§ Obstruction of its route ▪ Aqueducal stenosis
§ Decreased reabsorption
http://www.emsworld.com/article/11102879/can-‐hydrocephalus-‐cause-‐a-‐seizure (taken 06-‐01-‐2015)
8
¡ Poor feeding ¡ Irritability ¡ Reduced activity ¡ Vomiting
http://medicalpictures.net/hydrocephalus-‐pictures/ (taken 06-‐01-‐2015)
9
¡ Head enlargement: HC >98th percentile for age
¡ Dysjunction of sutures ¡ Dilated scalp veins ¡ Tense fontanelle ¡ Setting-‐sun sign ¡ Increased limb tone
http://www.hydroassoc.org/wp-‐content/uploads/2010/12/baby-‐klaus.jpg (taken 06-‐01-‐2015)
10
¡ Head circumference systematic measurements
¡ Skull radiograph ¡ Head CT Scan ¡ MRI ¡ Ultrasonography throught anterior fontanelle
11
An MRI scan of a brain with hydrocephalus (left) and a normal MRI scan. http://www.seattlechildrens.org/medical-‐conditions/brain-‐nervous-‐system-‐mental-‐conditions/hydrocephalus/ (taken 06-‐01-‐2015) 12
¡ Medical treatment: only to delay surgery § Acetazolamide
¡ Surgical treatment § Shunt (ventriculoperitoneal, ventriculoatrial)
§ Third ventriculostomy § Choroid plexectomy § Choroid plexus coagulation
http://neurosurgery.ufl.edu/patient-‐care/diseases-‐conditions/hydrocephalus/ (taken 06-‐01-‐2015) 13
¡ Hydrocephalus: CSF accumulation in brain due to overproduction, obstruction or decreased absorption
¡ Infant with enlarged head and neurological symptoms
¡ Best diagnostic tool à MRI ¡ Treatment à mostly surgery
14
¡ Rekate HL. A contemporary definition and classification of hydrocephalus.
Semin Pediatr Neurol. Mar 2009;16(1):9-‐15. ¡ Stephen L Nelson Jr, MD, PhD, FAAP, Hydrocephalus http://emedicine.medscape.com/article/1135286-‐overview (updated April 21, 2014)
16