Hydrocephalus Flashcards
Definition of hydrocephalus
Accumulation of CSF that usually results in ventricular expansion and pressure
Caused by inadequate absorption, loss of brain tissue due to atrophy, or obstruction
Subcortical disconnection syndrome due to injury to the long periventricular pathway (corpus callosum)
Different types are congenital and acquired and internal or external (external is in the subarachnoid space)
What is the neuropathology of hydrocephalus
Stretching and enlargement of the periventricular white matter tracts that cause a host of problems
CSF no longer able to remove toxins causing more damage
Affects glucose and oxygen utilization
Varies with type - DWS can see partial to complete agenesis of the cerebelo are vermis, corpus callosum issues
Risk factors for hydrocephalus
Certain syndromes that are congenital or can be acquired due to TBI that is obstruction
With conditions - spina bifada myelomeningocele occurs within the first 30 days of gestation when the vertebral column fails to fuse during embryogenesis - many caused by insufficient folic acid
Types of congenital hydrocephalus
Spina bífida myelomeningocele: 90% develop hydrocephalus due to Chiari II malformation which causes obstruction of the 4th ventricle - might have herniation with beaking and kinking - corpus callosum is usually abnormal (hypogenesis and hypoplasia)
Aqueductal stenosis: develops because of narrowing of the aqueduct
Dandy-Walker syndrome: 70-80% develop hydrocephalus because of cystic fourth ventricle with partial to complete agenesis of the cerebellar vermis (posterior fossa is enlarged) - partial or complete agenesis of the corpus callosum is common
Prematurity Intraventricular hemorrhage - have due to hemorrhage of the germinal matrix - is often arrested and not progressive
Incidence rates of hydrocephalus
Spina bífida accounts for 70% of all childhood cases of hydrocephalus
5-15% of cases are aqueductal stenosis
5-10% are Dandy Walker Syndrome
Determinants of severity of outcomes in hydrocephalus
Severity of hydrocephalus
Type of malformation
Damage to cerebellum and corpus callosum
Location of myelomeningocele (higher = more cognitive)
Treatments (shunt malformation)
In IVH correlates with birth weight and risk increases when weight decreases
IVH no difference with shunted and unshunted
Presentation
Acutely see headache, urinary incontinence, mental decline, issues with head control, gaze, cognitive difficulty and gait
In aqueductal stenosis people complain of headaches, unexpected vomiting, and see problems with head size, head control and gaze
Neuropsychological findings with hydrocephalus
Less prototypical pattern with low SES
Attention deficits but differs from aDHD and not as responsive to medications
EF measures are poor but improve with trials
Some nonverbal learning deficits (but hyper social and no memory problems) - VCI > PRI (especial tasks of motor speed)
Processing speed extremely deficient
Visual perception fine but configuration skills is impaired
Memory difficult but rote memory is intact
Sensorimotor deficits with upper extremities
Emotions - are hyper social, talkative, and intrusive
Word reading and spelling are lower
Intellectual disability is less frequent
Treatment of hydrocephalus
Can place a shunt to divert CSF - usually right posterior ventricular
Drains into the peritoneal cavity
Endoscopic third ventriculostomy is not a shunt
Shunts increase risk for infection but alleviates pressure
Some with spinal bifida get spinal surgeries to restore motor
