Hydrocephalus: Difference between revisions
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==Background== | ==Background== | ||
*Caused by excessive [[cerebrospinal fluid]] accumulation, often from an obstructive process such as [[CSF shunt malfunction]] or [[subarachnoid hemorrhage]] | |||
*Patients can also suffer from nonobstructive hydrocephalus due to excessive production of [[CSF]]<ref>Shprecher D. et al. Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 2008;8(5):371-376.</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Hydrocephalus with sunset eyes.jpg|thumb|Pediatric hydrocephalus with "sunset eyes."]] | |||
*[[Headache]] | *[[Headache]] | ||
*[[Diplopia]] | *[[Diplopia]] | ||
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*[[Nausea and Vomiting]] | *[[Nausea and Vomiting]] | ||
*[[Altered Mental Status]] | *[[Altered Mental Status]] | ||
===Pediatric=== | |||
''In addition to above:'' | |||
*Large fontanelles | |||
*Dilated scalp veins | |||
*"Cracked pot" sound on percussion | |||
*Irritability | |||
*Increased lower extremity tone | |||
*Remember that Babinski sign is normal up to 3 years of age | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Headache DDX}} | |||
== | ==Evaluation== | ||
[[File:Hydrocephalus (cropped).jpg|thumb|Typical hydrocephalus as seen on a brain CT. The lateral ventricles (black areas in the middle of the brain) are abnormally large and filled with fluid.]] | |||
[[File:Hydrocephalus.JPG|thumb|Obstructive hydrocephalus cause by a posterior fossa cyst in a 12 month old. Patient presented with loss of developmental milestones.]] | |||
*Physical Exam to assess for papilledema or neuro defects | *Physical Exam to assess for papilledema or neuro defects | ||
*CT Brain non contrast | *[[head CT|CT Brain]] non contrast | ||
**In acute cases will see dilated ventricles and tight sulci | **In acute cases will see dilated ventricles and tight sulci | ||
**In chronic cases (loss of tissue with age, alcoholism, etc) will see dilated ventricles with large amount of CSF in sulci | **In chronic cases (loss of tissue with age, alcoholism, etc) will see dilated ventricles with large amount of CSF in sulci | ||
==Management== | ==Management== | ||
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==See Also== | ==See Also== | ||
[[Normal pressure hydrocephalus]] | *[[Normal pressure hydrocephalus]] | ||
*[[Ventriculoperitoneal shunt obstruction]] | |||
==External Links== | ==External Links== | ||
Latest revision as of 20:57, 11 November 2020
Background
- Caused by excessive cerebrospinal fluid accumulation, often from an obstructive process such as CSF shunt malfunction or subarachnoid hemorrhage
- Patients can also suffer from nonobstructive hydrocephalus due to excessive production of CSF[1]
Clinical Features
- Headache
- Diplopia
- Ocular Palsy - 6th nerve palsy, strabismus
- Papilledema
- Nausea and Vomiting
- Altered Mental Status
Pediatric
In addition to above:
- Large fontanelles
- Dilated scalp veins
- "Cracked pot" sound on percussion
- Irritability
- Increased lower extremity tone
- Remember that Babinski sign is normal up to 3 years of age
Differential Diagnosis
Headache
Common
Killers
- Meningitis/encephalitis
- Myocardial ischemia
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Giant cell arteritis of temporal artery (temporal arteritis)
- Idiopathic intracranial hypertension (Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
- Carotid artery dissection
Others
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Tuberculosis
- Lyme disease
- Syphilis
- Leptospirosis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
Evaluation
.jpg)
- Physical Exam to assess for papilledema or neuro defects
- CT Brain non contrast
- In acute cases will see dilated ventricles and tight sulci
- In chronic cases (loss of tissue with age, alcoholism, etc) will see dilated ventricles with large amount of CSF in sulci
Management
Disposition
See Also
External Links
References
- ↑ Shprecher D. et al. Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 2008;8(5):371-376.