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Hydrocephalus
Physiology - CSF
- 95% from choroid plexus
- ~0.5 l / day produced
- <0.5g / l protein
- electrolytes match plasma
- no WBC, RBC
Presentation
- Visual problems – papilloedema over few months
- Nausea & Vomiting
- Abnormal head and bulging fontanelles
- Not feeding / headache
Types
- Communicating – all dilated – blood , esp. in subarachnoid
haemorrhage, (babies) intraventricular haemorrhage
- Obstructive – some dilated – infection, idiopathic, aqueduct stenosis
Treatment
- Ventriculo-peritoneal / -pleural / -r. atrium shunt
- 3rd ventriculostomy
- External shunting
- acetazolamide
Shunts
- Ventricular catheter, valve, distal catheter
- Problems – infection, blockage
- Symptoms of infection – very vague, diagnosed by CSF culture, treat by
shunt removal or intrathecal antibiotics
- Blockage – sunsetting (failure of upward gaze ? due to pressure of
tectal plate), enlarging head, bulging fontanelles
- Investigation – CT(best), X-ray series
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