CASE PRESENTATION

HYDROCEPHALUS

PRESENTED BY:
EDDELYN UPANTO(NICU)
 DEMOGRAPHIC DATA

• case #: 190***
• age: 21 days
• sex: male
• diagnosis: severe hydrocephalus
• ward: nicu
 PHYSICAL ASSESSMENT

• General Appearance
• Weak in appearance
• Restless
• With OGT F5
• Wt.=2.46kg, Lt.=42cm, HC=34.5cm
 SKIN

• Pinkish
• Warm to touch
• Slightly dry
• Scaly
• Thin
 HEAD AND NECK
• Bulging Fontanels
• Facial symmetry
• Iris is black, pupils are equal, round reactive
to light
• Cloudy cornea
• Conjunctiva are pale
• No inflammation and discharges noted
• Has both patent and equal nosetrills
 
 DISCUSSION OF THE DECEASE:

Hydrocephalus also known as "water on the

brain," is a medical condition in which there is an
abnormal accumulation of cerebrospinal fluid
(CSF) in the ventricles, or cavities, of the brain.
This may cause increased intracranial pressure
inside the skull and progressive enlargement of
the head, convulsion, tunnel vision, and mental
disability. Hydrocephalus can also cause death.
The name derives from the Greek words (hydro-)
"water", and (kephalos) "head".
 CLASSIFICATION

Based on its underlying mechanisms, hydrocephalus can be classified into

communicating and non-communicating (obstructive). Both forms can
be either congenital or acquired.
• Communicating
• Communicating hydrocephalus, also known as non-obstructive
hydrocephalus, is caused by impaired cerebrospinal fluid resorption in the
absence of any CSF-flow obstruction between the ventricles and
subarachnoid space. Various neurologic conditions may result in
communicating hydrocephalus, including subarachnoid/intraventricular
hemorrhage, meningitis and congenital absence of arachnoid villi. Scarring
and fibrosis of the subarachnoid space following infectious, inflammatory,
or hemorrhagic events can also prevent resorption of CSF, causing diffuse
ventricular dilatation.]
 NON-COMMUNICATING
• Non-communicating hydrocephalus, or
obstructive hydrocephalus, is caused by a
CSF-flow obstruction ultimately preventing
CSF from flowing into the subarachnoid space
(either due to external compression or due to
intraventricular mass lesions).
 CONGENITAL
• The cranial bones fuse by the end of the third year of
life. For head enlargement to occur, hydrocephalus
must occur before then. The causes are usually
genetic but can also be acquired and usually occur
within the first few months of life, which include:
• 1) Intraventricular matrix hemorrhages in premature
infants,
• 2) Infections
• 3) Type II Arnold-Chiari malformation
• 4) Aqueduct Atresia and stenosis
• 5) Dandy-Walker malformation
 ACQUIRED

• This condition is acquired as a consequence of

CNS infections, meningitis, brain tumors,
head trauma, intracranial hemorrhage
(subarachnoid or intraparenchymal) and is
usually extremely painful.
ANATOMY AND PHYSIOLOGY
 PATHOPHYSIOLOGY OF HYDROCEPHALUS
 
 
• If there is obstruction in the ventricular system or the subarachnoid space, dilated cerebral ventricles, causing ventricular
surface wrinkle, and tearing ependymal lines. White mater below it will atrophy and reduced to a thin ribbon. In the gray
matter there is maintenance that is selective, so that although ventricular enlargement gray matter has been experiencing a
disruption. Dilation process can be a sudden process / acute and can also selectively depending on the position of the
blockage. The process was a case of acute emergency. In infants and small children cranial suture folds and widened to
accommodate increased cranial mass. If the anterior fontanela not closed then it will not expand and feel tight in touch.
Stenosis aquaductal (family illness / adrift offspring sex) causes dilation of the ventricles laterasl point and center, this
dilation causes the appearance of distinctive shaped head protruding forehead is dominant (dominant frontal blow).
Syndroma dandy walkker would happen if there is obstruction at the foramina outside the IV ventricle. Fourth ventricle
dilated and prominent posterior fossae meet most of the space under the tentorium. Clients with type hydrocephalus above
will have an enlarged cerebrum which is symmetric and disproportionately small face.
•  
• In older people, cranial sutures had closed thus limiting the expansion of the brain, as the result showed the symptoms:
increase in ICP before the cerebral ventricles, becomes greatly enlarged. Damage in the absorption and circulation of CSF in
hydrocephalus incomplete. CSF exceeds the normal capacity of the ventricular system, every 6-8 hours and the total absence
of absorption will cause death.
• In ventricular dilation causes tearing of the line normal ependyma, which allows an increase in the wall cavity absorption. If
the route collateral sufficient to prevent further ventricular dilatation there will be a state of compensation.
 ETIOLOGY
• Blockage of cerebrospinal fluid (CSF) can be caused by a variety of
conditions such as: spina bifida and other birth defects of the
brain; certain brain infections like meningitis (pus can cause a
blockage); hemorrhage within or around the brain, usually due to
prematurity or a ruptured aneurysm; and brain trauma, or
tumouhyrors. The blockage can occur within the ventricles
themselves (obstructive hydrocephalus), or outside the brain in the
areas where the spinal fluid is reabsorbed back into the blood
stream (communicating hydrocephalus).
• The term congenital refers to cases where hydrocephalus is present
at birth, but without any genetic factors. In cases of congenital
hydrocephalus, it is usually not possible to determine the cause, and
this is referred to as 'idiopathic'. In these cases, one assumes that
the condition arose before birth, in the form of developmental
problems due to infections, problems with blood supply, etc.
 SIGNS AND SYMPTOMS
• Signs and symptoms of infant with severe hydrocephalus:
•
Eyes that appear to gaze downward
• Irritability
• Seizures
• Separated sutures
• Sleepiness
• Vomiting
•
Symptoms that may occur in older children can include:
•
Brief, shrill, high-pitched cry
• Changes in personality, memory, or the ability to reason or think
• Changes in facial appearance and eye spacing
• Crossed eyes or uncontrolled eye movements
• Difficulty feeding
• Excessive sleepiness
• Headache
• Irritability, poor temper control
• Loss of bladder control (urinary incontinence)
• Loss of coordination and trouble walking
• Muscle spasticity (spasm)
• Slow growth (child 0–5 years)
• Slow or restricted movement
• Vomiting
 
 EFFECTS
• Because hydrocephalus can injure the brain, thought and
behavior may be adversely affected. Learning disabilities
including short-term memory loss are common among
those with hydrocephalus, who tend to score better on
verbal IQ than on performance IQ, which is thought to
reflect the distribution of nerve damage to the brain.
However the severity of hydrocephalus can differ
considerably between individuals and some are of
average or above-average intelligence. Someone with
hydrocephalus may have motion and visual problems,
problems with coordination, or may be clumsy. They may
reach puberty earlier than the average child. About one
in four develops epilepsy.
 TREATMENT
• Hydrocephalus treatment is surgical, generally creating various types of
cerebral shunts. It involves the placement of a ventricular catheter (a
tube made of silastic), into the cerebral ventricles to bypass the flow
obstruction/malfunctioning arachnoidal granulations and drain the
excess fluid into other body cavities, from where it can be reabsorbed.
Most shunts drain the fluid into the peritoneal cavity (
ventriculo-peritoneal shunt), but alternative sites include the right atrium
(ventriculo-Atrial shunt), pleural cavity (ventriculo-pleural shunt), and
gallbladder. A shunt system can also be placed in the lumbar space of the
spine and have the CSF redirected to the peritoneal cavity (
Lumbar-peritoneal shunt). An alternative treatment for obstructive
hydrocephalus in selected patients is the
endoscopic third ventriculostomy (ETV), whereby a surgically created
opening in the floor of the third ventricle allows the CSF to flow directly
to the basal cisterns, thereby shortcutting any obstruction, as in
aqueductal stenosis. This may or may not be appropriate based on
individual anatomy.
 SHUNT COMPLICATIONS

• Examples of possible complications include shunt malfunction, shunt

failure, and shunt infection, along with infection of the shunt tract following
surgery (the most common reason for shunt failure is infection of the shunt
tract). Although a shunt generally works well, it may stop working if it
disconnects, becomes blocked (clogged), infected, or it is outgrown. If this
happens the cerebrospinal fluid will begin to accumulate again and a
number of physical symptoms will develop (headaches, nausea, vomiting,
photophobia/light sensitivity), some extremely serious, like seizures.
• Another complication can occur when CSF drains more rapidly than it is
produced by the choroid plexus, causing symptoms -listlessness, severe
headaches, irritability, light sensitivity, auditory hyperesthesia (sound
sensitivity), nausea, vomiting, dizziness, vertigo, migraines, seizures, a
change in personality, weakness in the arms or legs, strabismus, and
double vision - to appear when the patient is vertical.
 
 NURSING PROBLEM
PRIORITIZATION
• Acute pain
• Delayed growth and development
• Imbalanced nutrition: Less than body
requirements
• Gas exchange
• Ineffective tissue perfusion: Cerebral.
• Interrupted family processes.
• Infant Behavior, risk for disorganized.
• Risk For Infection
 NURSING CARE PLAN
Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective: Ineffective After 12 hours of  Temperature monitored. Tepid  Fever may reflect damage to After 12 hours of
“I noticed that the size of cerebral tissue nursing interventions sponge bath administered in hypothalamus. Increased nursing intervention
my baby’s head is not perfusion related the patient will presence of fever. metabolic needs and oxygen the patient was able
normal” as verbalized by to decreased demonstrate improved  Intake and output monitored. consumption occurs which can to demonstrate
the mother. arterial or venous vital signs and Weigh as indicated. Skin further increase ICP. improved vital signs
Objective: blood flow. absence of increased turgor, status and mucus  Useful indicator of body water and absence of
 Restlessness ICP. membrane noted. which an important part of tissue increased ICP.
 Irritability  Head/neck midline or neutral perfusion.
 Change in vital position, support with towel  Turning head to one side
signs rolls or small pillow compress the jugular veins and
 Vital signs taken maintained. inhibits cerebral venous drainage
as follows:  Provided rest periods between that may cause increased ICP.
T=37.8 degrees care and limit durations of  Continuous activity can
Celsius procedures. increased ICP by producing a
P=158bpm  Decreased extraneous stimuli cumulative stimulant effect.
RR=52bpm and provide comfort measures  Provides calming effect reduces
such as quiet environment and adverse physiological response
gentle touch. and promotes rest.
 Helped limit or avoid  These activities increase
coughing, crying, vomiting and intrathoracic and intra-
straining at stool. abdominal pressure.
 Elevated head of the bed  Promote venous drainage from
gradually at 15-30 degrees as head, reducing cerebral
tolerated or indicated. congestion and edema and
Collaborative: increased ICP.
 Diuretics administered as  Diuretics may used in acute
indicated. phase to draw water from brain
 Supplemental oxygen cells reducing cerebral edema
administered as indicated. and ICP.
 Reduces hypoxemia which may
increase cerebral vasodilation
and blood volume.
 REFERENCE:

• ^http://www.nlm.nih.gov/medlineplus/ency /article/001571.htm Accessed 19 June 2010

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