Hydrocephalus

Definition Hydrocephalus is the result of buildup of CSF in the ventricles of the brain Fig Hydrocephalus and Ventriculoperitoneal Shunts

Definition 3D rendering of ventricles (lateral and anterior views).

The ventricular system accounts for the production and circulation of cerebrospinal fluid

Pathology This occurs when an imbalance exists in the amount of CSF produced and the amount absorbed, in case of: o Noncommunicating ventricles that obstruct the outflow of CSF from the ventricles can produce this phenomenon o as can an Arnold-Chiari malformation o or occasionally a tumor.

Diagnosis Definitive diagnosis may by made by: o Sonography scan o Computed tomography scan(CT) o Magnetic resonance imaging scan (MRI)

Symptoms An early sign of the condition in infants is an enlarged head. In an older child, whose head cannot grow, intracranial pressure increase.

Symptoms Clinical signs of hydrocephalus in infants include: o Abnormal head growth, with bulging fontanels o Dilated scalp veins o Separated sutures; eyes that appear to deviate downward, producing a “sunset” appearance of the iris

Symptoms Clinical signs of hydrocephalus in infants after time include: o lethargy o Irritability o Problems with reflexes, feeding, and tone

Symptoms Clinical signs of hydrocephalus in older children may include: o Headache o Irritability o Development of nystagmus o Cognitive changes

Complications The pressure produced by the hydrocephalus can result in: o Visual and perceptual deficits o Cognitive impairment o Seizures o In extreme cases, death

Complications Children with hydrocephalus may demonstrate: o Sensory processing o Perceptual problems o Often they exhibit fine motor delays in association with visual-perceptual impairment or apraxia

OT roles With problems in sensory, neuromotor, and perceptual performance areas. Therapists often emphasize: o Self-care o Instrumental ADLs o Functional mobility skills

Treatment If the condition caused by an obstruction: Removal of the obstruction may alleviate the condition. The usual medical treatment for idiopathic hydrocephalus is : Placement of a ventriculoperitoneal (VP) shunt.

Treatment

Treatment

Treatment

Treatment  (VP) shunt reduce the CSF pressure by means of a catheter that runs under the skin from one of the ventricles to the abdominal cavity, when the fluid can be absorbed safely.

Treatment  These shunt are usually effective but must be monitored regularly for: o signs of infection o Clogging o Kinking o Migration of the tube

Complications Even with shunting, however, many of these children have : o Cognitive problems o Perceptual problems o Visual problems o Other functional problems

Reference Case-Smith, J. (Ed.). (2010). Occupational therapy for children (6th ed.). St. Louis: Mosby.