hydrocephalic

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hy·dro·ce·phal·ic

(hī'drō-se-fal'ik),
Relating to or suffering from hydrocephalus.

hy·dro·ce·phal·ic

(hī'drō-sĕ-fal'ik)
Relating to or suffering from hydrocephalus.

hydrocephalus

(hi-dro-sef'a-lus) [? + kephale, head]
The accumulation of excessive amounts of cerebrospinal fluid (CSF) within the ventricles of the brain, resulting from blockage or destruction of the normal channels for CSF drainage. Common causes include congenital lesions (e.g., spina bifida or aqueductal stenosis), traumatic lesions, neoplastic lesions, and infections such as meningoencephalitis. Sometimes the accumulated fluid leads to increased intracranial pressure (ICP). Synonym: hydrencephalushydrocephalic (hi?dro-se-fal-ik), adjective

Treatment

Several neurosurgical procedures are used to treat hydrocephalus. The most commonly used procedure has been to establish a conduit for CSF (called a “shunt”) from the ventricles of the brain to the peritoneal cavity or the right atrium.

Prognosis

The prognosis for an uncomplicated course is excellent when hydrocephalus is promptly treated by use of a surgically instituted shunt.

Patient care

Vital signs and neurological status are monitored hourly or as necessary according to institutional protocol or the surgeon's directions. The infant's anterior fontanel is inspected for bulging and the head circumference measured (an indelible ink mark on the forehead ensures that all measurements are at the same location). The patient is positioned as directed by the surgeon, usually on the nonoperative side with the head level with the body. Fluid intake and output are monitored, and IV fluids are administered as prescribed. The patient is assessed for vomiting (an early sign of increased ICP and shunt malfunction). The patient is monitored for signs of infection (esp. meningitis) such as fever, stiff neck, irritability, or tense fontanels. The area over the shunt tract also is inspected for redness, swelling, and other signs of local infection. Dressings are checked for drainage and the wound redressed as necessary using aseptic technique. The patient also is observed for other signs and symptoms of postoperative complications, such as adhesions, paralytic ileus, peritonitis, migration of the shunt, intestinal perforation (with peritoneal shunt), and dehydration and septicemia. The infant's head, neck, and shoulders are moved as a unit with the rest of the body to prevent neck strain during position changes. The family is taught postoperative care measures, including watching for signs of shunt malfunction, infection, and paralytic ileus. Maternal bonding is encouraged. The parents are assisted to set goals consistent with the patient's ability and potential; the family should focus on the child's strengths rather than weaknesses. They should be made aware that shunts will need to be surgically lengthened periodically as the child grows, and that surgery also may be required to correct shunt malfunctions. Special education programs also are discussed with the parents; the infant's need for sensory stimulation appropriate to age is emphasized.

communicating hydrocephalus

Hydrocephalus that maintains normal communication between the fourth ventricle and subarachnoid space.

congenital hydrocephalus

Hydrocephalus occurring in newborns, typically caused by birth defects such as spina bifida, aqueductal stenosis, or birth trauma with ventricular hemorrhage.

In congenital hydrocephalus, the faulty drainage of CSF from the ventricles of the brain often results in rapidly increasing head circumference, malformation of the skull (thin bone with widened fontanels and separated sutures), distended scalp veins, thin, shiny scalp skin, weak neck muscles incapable of supporting the head, and abnormal development of psychomotor and cognitive or language skills. In untreated cases of congenital hydrocephalus, the outcome is fatal in about half of the patients due to infection, malnutrition, or increased intracranial pressure. The parents of infants treated neurosurgically for congenital hydrocephalus are instructed in signs and symptoms that may indicate surgical complications: fever and headache, irritability, poor feeding, inconsolability.

external hydrocephalus

An accumulation of fluid in subdural spaces.

hydrocephalus ex vacuo

The appearance on brain imaging of enlarged lateral ventricles, caused by atrophy of the brain.

internal hydrocephalus

An accumulation of fluid within ventricles of the brain.

noncommunicating hydrocephalus

Hydrocephalus in which a blockage at any location in the ventricular system prevents flow of cerebrospinal fluid to the subarachnoid space.

normal pressure hydrocephalus

A type of hydrocephalus with enlarged ventricles of the brain with no increase in the spinal fluid pressure or no demonstrable block to the outflow of spinal fluid. Shunting fluids from the dilated ventricles to the peritoneal cavity may be helpful. The classic triad of symptoms includes disturbances of gait, progressive dementia, and urinary incontinence.

secondary hydrocephalus

Hydrocephalus following injury or infections such as meningitis or syphilis.