hydrocephalus

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Author:
joyjohnson
ID:
142709
Filename:
hydrocephalus
Updated:
2012-03-20 09:59:29
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hydrocephalus
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Description:
hydrocephalus
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  1. Hydrocephalus
    excessive accumulation of cerebrospinal fluid (CFS) within the ventricles of the brain

    occurs most often in newbornsalso in adults as result of injury/disease

    occurs when an imbalance exists in the amount of CSF produced and the amount absorbed

    enlarges head in infants

    compression of brain tissue = brain damage in infants and adults

    with early detection and surgical intervention, prognosis improves, but remains guarded

    after surgery,complications: mental retardation, impaired motor function, and visual loss

    w/o surgery prognosis poor

    mortality may result from increased intracranial pressure in all ages

    infants may also die prematurely of infection/malnutrition
  2. CAUSES
    noncommunicating hydrocephalus
    an obstruction in the CSF flow

    obstruction occurs most frequently between the 3rd and 4th ventricles at the Aqueduct of Sylvius

    • This obstruction may result from:
    • faulty fetal developement
    • infection(syphilis, meningitis)
    • tumor
    • cerebral aneurysm
    • blood clot (after intracranial hemorrhage)
  3. CAUSES
    communicating hydrocephalus
    myelomeningocele

    adhesions between meninges at the base of the brain

    meningeal hemorrhge

    rarely caused by a tumor
  4. signs/symptoms
    • infants:
    • enlargement of head, disaprotionate, buldging fontanels
    • distended scalp-dilated veins
    • thin, fragil/shiny scalp
    • eyes deviate downward-sunset eyes
    • underdeveloped neck muscles
    • high-pitched shrill cry
    • irritability
    • problems with reflexes, feeding and tone

    • ADULTS/CHILDREN
    • decreased level of consciousness
    • headache
    • irritability
    • ataxia
    • incontinence
    • impaired intellect
  5. DIAGNOSIS
    • based upon signs/symptoms
    • sonography
    • computed tomography(CT)
    • MRI-there is a need to differentiate between hydrocephalus and intracranial lesions
  6. ARNOLD-CHIARI DEFORMITY
    occurs w/ hydrocephalus

    specific deformity/impairs drainage of CSF

    requires surgical repair
  7. ARNOLD-CHIARI
    TREATMENT
    surgical correction is the only treatment

    usually consists of insertion of a ventriculoperitoneal which transports excess fluid from the lateral ventricle to the peritoneal cavity

    • less common:
    • ventriculoatrial shunt which drains from the brain's lateral ventricle into the right atrium of the heart
    • fluid becomes part of the venous circulation
  8. complications of surgery
    infection of the shunt

    shunt will need revisions as the child grows or with malfunction

    • special considerations related to the shunt:
    • note general behavior, epecially irritability, apathy or decreased level of consciousness

    • encourage maternal/infant bonding
    • hold the baby, stroke/cuddle, speak softly
    • avoid vestibular stimulation

    prevent skin breakdown/earlobe flat and placed on sheepskin or rubber foam mattress

    when turning, move head/neck/shoulders with the body to reduce strain on the neck
  9. after surgery
    place the infant on the side oposite the operative site unless the doctor orders otherwise

    • watch for signs of infection:
    • fever, stiff neck, irritability, redness, swelling, other signs of local infection over the shunt tract

    check the infant's growth and development periodically and help the parents set goals consistent with the infant's abilities
  10. FUTURE CARE
    sensory stimulation appropriate to age of the infant

    special education programs when school age

    • shunts do need revisions
    • periodic surgery to lengthen the shunt as the child grows older

    to correct malfunctioning

    to treat infection

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