1. Hydrocephalus

2. Volume of brain= 1400 ml
Volume of CSF= 150ml (75+75)
CSF in ventricles around 25 ml
Volume of blood= 150 ml
Total volume of CSF (adult) = ml
Total volume of CSF (infant) = 50 ml
Monro-Kellie relation: the volume inside the cranium is CONSTANT.

3. CSF Secretion
Cerebrospinal fluid is secreted by the epithelial cells of the choroid plexuses.
These cells like those of other secretory epithelia are polarised so that the properties of their apical membrane (ventricle facing) differ from those of the basolateral membrane (blood facing).

4. Pink: Lateral Ventricles
Green:3rd and 4th vent
Red:Choroid plexi

5. CSF Circulation

6. Normally, CSF flows continually from the ventricles to the subarachnoid space that surrounds the brain and spinal cord.

7. The balance between production and absorption of CSF is critically important. Because CSF is made continuously, medical conditions that block its normal flow or absorption will result in an over-accumulation of CSF.  The resulting pressure of the fluid against brain tissue is what causes Hydrocephalus.

8. Causes Of CSF Obstruction

9. Definition
Excessive accumulation of cerebrospinal fluid resulting in abnormal widening of ventricles.

10. Types of Hydrocephalus
There are several different types of Hydrocephalus:
Congenital hydrocephalus
Acquired hydrocephalus
Communicating hydrocephalus
Non-communicating hydrocephalus
Hydrocephalus ex-vacuo
Normal Pressure Hydrocephalus

11. Congenital Hydrocephalus
Congenital hydrocephalus is present at birth and may be caused by environmental influences during fetal development or by genetic factors.
Causes are:
Aqueduct Stenosis
Colloid Cyst

12. Acquired Hydrocephalus
Develops at the time of birth or at some point afterward. This type of hydrocephalus can affect individuals of all ages and may be caused by injury or disease.

13. Acquired Hydrocephalus is due to:
Tumors
Hemorrhage
Ventriculitis

14. Communicating Hydrocephalus
Communicating hydrocephalus occurs when the flow of cerebrospinal fluid (CSF) is blocked after it exits the ventricles. This form is called communicating, because the CSF can still flow between the ventricles, which remain open.

15. Causes are due to: Post-hemorrhage Bacterial Meningitis
Malignant Meningitis
Increased Venous Pressure

16. Non-Communicating Hydrocephalus
Non-communicating hydrocephalus, also called "obstructive" hydrocephalus, occurs when the flow of CSF is blocked along one or more of the narrow pathways connecting the ventricles.
Causes include:
Congenital
Acquired

17. Hydrocephaly is often suggested as the cause of the unusual parietal bossing (bulging of the bones at the rear sides of the skull) in the Starchild Skull.

19. Ex-Vacuo
Occurs when stroke or traumatic injury damages the brain. In these cases brain tissue may actually shrink.

20. Normal Pressure Hydrocephalus
More common among the elderly.
It may result from a SAH, head trauma, infection, tumor or surgery complication.
However many people develop normal pressure hydrocephalus when none of these factors are present for unknown reasons.

21. Symptoms
Symptoms vary with age, disease progression and individual differences to tolerance to this condition. (infant vs adult)
The infant skull can expand to accomodate the buildup of CSF because of sutures have not yet closed.

22. Infant
In infancy the most obvious indication for hydrocephalus is a rapid increase in head size.
Other symptoms:
Vomiting
Sleepiness
Irritability
Downward eye deviation(SUNSETTING)
Seizures

23. Adults
Older children and adults shows different symptoms since head cannot expand.
Headache
Vomiting
Nausea
Papilledema
Blurred or double vision
Sunsetting

24. Balance problems
Poor coordination
Gait disturbances
Urinary incontinence
Slowing or loss of developement
Lethargy, drowsiness, irritability
Personality or cognition changes
Memory loss

25. Diagnosis
Hydrocephalus is diagnosed through clinical neurological evaluation and by using cranial imaging techniques such as USG, CT, MRI and pressure monitoring techniques.
Based on age, clinical presentation, and known abnormalities.

26. Aqueduct Stenosis on MRI-Sagittal

27. Treatment
Hydrocephalus is often treated by surgically inserted shunt system. System diverts the flow of CSF from the CNS to another area where it can be absorbed.
A limited number of individuals can be treated with Third ventriculostomy. By a neuroendoscope, a tiny hole is made on the floor of 3rd ventricle.

29. Complications Mechanical Failure Infections Obstructions Overdraining*
Underdraining

30. Headache
Subdural hematoma
Slit-Ventricle Syndrome