2. Dr.Anum Maqbool (PT) HYDROCEPHALUS BY Muhammad Arslan Yasin Umair Khilji To

3. The term hydrocephalus is derived from two words: "hydro" meaning water, and "cephalus" referring to the head. Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (fluid-containing cavities) of the brain and may increase pressure within the head. Hydrocephalus

5.  Cerebrospinal fluid is a clear, colorless body fluid found in the brain and spinal cord.  It is produced by the specialized ependymal cells in the choroid plexuses of the ventricles of the brain, and absorbed in the arachnoid granulations. CSF

6. CSF has three crucial functions: 1)It acts as a "shock absorber" for the brain and spinal cord. 2)It acts as a vehicle for delivering nutrients to the brain and removing waste. 3)It flows between the cranium and spine to regulate changes in pressure within the brain.

7. Common Causes of Hydrocephalus  Hydrocephalus can be inherited genetically  May be associated with developmental disorders, including spina bifida (congenital defect of the spine) and encephalocele (hernia of the brain).  Bleeding within the brain  Brain tumors  Head injuries  Complications of premature birth such as hemorrhage  Diseases such as meningitis or other infections.

8. Causes Of Hydrocephalus: InheritedAcquired MyelodisplasiaTumur Atresia of foramen of monoroMeningitis Neural tube defects:  Ecenphalocele  Spina bifida Infection Genetic abnormalities:  Aqueductal stenosis  Dandy walker complex Hemorrhage Other cerebral & spinal malfunctionsArchinoid cyst Tramautic brain injury Ideopathic

9.  Hydrocephalus is often categorized for age groups as either congenital or normal pressure hydrocephalus. I.Congenital hydrocephalus refers to conditions that are caused by conditions existing at birth. Primary symptoms include headache, nausea, vomiting and drowsiness. II.Normal pressure hydrocephalus (NPH) is the accumulation of cerebrospinal fluid that causes the ventricles in the brain to become enlarged, with little or no increase in pressure. Adult-onset NPH mainly occurs in adults age 60 and older. Patients with NPH often get misdiagnosed with Alzheimer’s disease or dementia, as some of the symptoms mimic these two conditions.() Ideopathic

10. Unspecified ( NPH ) A clinical symptom complex caused by the build-up of cerebrospinal fluid.

11. Symptoms of Hydrocephalus in infants  Abnormal enlargement of the head  Soft spot (fontanel) is tense and bulging  Scalp can appear thin  Bones separated in baby's head  Prominent scalp veins  Vomiting  drowsiness  Irritability  Downward deviation of baby's eyes  Seizures  Poor appetite.

12.  Abnormal enlargement of baby's head.  Headache  Nausea  Vomiting  Fever  blurred or double vision  unstable balance  Irritability  Sleepiness  delayed progress in walking or talking  poor coordination  change in personality  inability to concentrate  loss of sensory motor functions  Seizures  poor appetite.  poor learning in school. Symptoms of Hydrocephalus in toddlers/children

13.  Headache  Difficulty in remaining awake or waking up  Loss of coordination or balance  Bladder control problems  Impaired vision  Impaired cognitive skills that may affect job performance and personal skills. Symptoms of Hydrocephalus in young and middle-aged adults

14.  Loss of coordination or balance  Shuffling gait  Memory loss  Headache  Bladder control problems. Symptoms of Hydrocephalus in older adults Normal pressure hydrocephalus (NPH) is typically characterized by a triad of symptoms: gait disturbance, mild dementia and impaired bladder control.

16. Before your doctor can recommend a course of treatment, he or she will:  Review your medical history, and perform a physical examination  Perform a complete neurological examination including diagnostic testing if needed  Ask specific questions to determine if symptoms are caused by hydrocephalus Diagnosing Hydrocephalus

17. The neurological examination will also help to determine the severity of your condition.  Further tests such as: I.An ultrasound (if the patient is an infant) II.Computed tomography (CT or CAT scan) III.Magnetic resonance imaging (MRI) may be ordered IV.A manometer tube The range of normal cerebrospinal fluid (CSF) pressure in children (10 th to 90 th percentile) at the time of lumbar puncture is 12 to 28 cmH 2 O (9 to 21 mmHg)

18. Treatment Hydrocephalus can be treated in a variety of ways. The problem area may be treated I.Directly (by removing the cause of CSF obstruction) II.Indirectly (by diverting the fluid to somewhere else; typically to another body cavity) III.An alternative operation called endoscopic third ventriculostomy utilizes a tiny camera (endoscope) to look inside the ventricles, allowing the surgeon to create a new pathway through which CSF can flow.

19. Directly Endoscopic third ventriculostomy Indirectly

20.  Indirect treatment is performed by implanting a device known as a Shunt to divert the excess CSF away from the brain. Shunts will generally consist of three components: An inflow catheter – This drains the CSF from the ventricles. It leaves the brain through a small hole in the skull, which then runs under the skin. A valve mechanism – This regulates the pressure control through the shunt tubing. It is connected to the catheter and lies between the skin and the skull, usually on top of the head or behind the ear. An outflow catheter – This runs under the skin and moves the CSF from the valve to the peritoneal cavity, heart or other drainage site.

22. Ventriculoperitoneal (VP) Shunt VP shunts are the most common type of shunt for draining excess CSF. These shunts generally contain a pressure-sensitive valve that releases CSF once the pressure reaches a certain level. In VP shunts, a catheter is inserted into the ventricle with tubing tunnelled subcutaneously down the thorax and then further tunnelled into the peritoneal cavity where the CSF is absorbed. Ventriculoatrial (VA) Shunt VA shunts are less common than VP shunts and the only difference between them is that rather than finishing in the peritoneal cavity, the VA shunt finishes in the right atrium of the heart and CSF is absorbed via our blood stream. Lumboperitoneal (LP) Shunt An LP shunt consists of a catheter inserted between two lumbar vertebras into the thecal space, which is then tunnelled around the abdomen into the peritoneal cavity for absorption. Types Of Shunts:

24.  Obstructions, malposition  Shunt infections cardiac complications such as  Endocarditis  Traumatic perforation  Heart failure  Tricuspid regurgitation  Intra-atrial thrombus  Pulmonary hypertension are reported. Various complication of VA shunt such as

25. Complications of Shunts These complications can be divided into two categories as either arising from: 1.A mechanical complication 2.A biological complication Mechanical complications of a shunt include: Malfunctions such as Leaks Obstruction Migration discontinuity. The biological complications of a shunt include: Infection Abscess Pseudocyst Haemotoma Peritonitis

26. Recovery Follow-up diagnostic tests including CT scans, MRIs and x-rays, are helpful in determining if the shunt is working properly. Do not hesitate to contact your physician if you experience any of the following postoperative symptoms:  Redness, tenderness, pain or swelling of the skin along the length of the tube or incision  Irritability or drowsiness  Nausea, vomiting, headache or double vision  Fever  Abdominal pain  Return of preoperative neurological symptoms

27. Prognosis The prognosis for hydrocephalus depends on the cause, the extent of symptoms, and the timeliness of diagnosis and treatment.  Some patients show a dramatic improvement with treatment while others do not.  In some instances of NPH, dementia can be reversed by shunt placement.  Other symptoms such as headaches may disappear almost immediately if the symptoms are related to elevated pressure.

28. Does Physiotherapy Kuch kray gi….? ?

29. 4 Detailed readings visit…. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Hydrocephalus-Fact-Sheet https://www.ausmed.com/cpd/articles/hydrocephalus-and-shunts Note: To open link directly from here, first hold ctrl key and then click on the link. https://www.hydroassoc.org/pt-tips-for-nph-patients/ https://www.graphic.com.gh/news/health/physiotherapy-management-of-hydrocephalus.html

30. Any Question?