1. Dr. VASHDEV KHIMANI ASSISTANT PROFESSOR DEPT. OF NEUROSURGERY LUMHS JAMSHORO

3. Hydrocephalus derived from Greek word means water on brain. It is an abnormal accumulation of CSF in ventricles or cavities of brain

6. Functions of CSF 1. Shock absorber 2. Delivering nutrients to the brain removing waste products. 3. Flow between cranium & spine & compensate for changes in intracranial blood volume.

7. Ventricular system is made up of 4 ventricles 2 lateral ventricles Third ventricle 4 th ventricle

8. Flow of CSF

9. Congenital: T hat present at birth Genetic defects (Aqueduct stenosis) Developmental defect (Neural tube defect) Intraventricular hemorrhage complication of premature birth.

10. Aqueduct of Stenosis.

11. Intraventricular Hemorrhage.

12. Causes. ACQUIRED : That present after the birth Meningitis Brain tumor Traumatic head injury Subarachnoid hemorrhage.

13. Meningitis

14. Brain tumor

15. Traumatic head injury

16. Subarachnoid hemorrhage.

17. Normal pressure hydrocephalus (NPH) Triad of(Gate disturbance, urinary incontinence, dementia ).

18. NPH

19. Ex vacuo hydrocephalus Present when brain insult leads atrophy

20. Ex vacuo hydrocephalus

21. Pediatric age group Irritability, poor feeding, lethargic, vomiting, delayed milestones. SIGNS Increase OFC (occipitofrontal circumference) Visible scalp veins Sunset eye phenomenon Bulging fontenella

22. Adult age group Headache Vomiting Blurred vision Dizziness Altered level of consciousness Papilloedema Cushing triad (Bradycardia, Hypertension, Respiratory irregularities)

23. Routine hematological Ultrasound brain CT scan brain MRI brain

24. Ultrasound brain Size of ventricles Corticomantle thickness

25. Normal Ctscan Abnormal Ctscan

27. When CSF is clear Patient is a febrile Normal CSF status Glucose 40-60mg/dl protein 15-40mg/dl Cells 0-5/cm predominantly lymphocyte

28. Flow is essence of life

29. Lumber puncture

30. Fontenella tapping

32. Specific Treatment Brain bypass surgery Ventriculoperitoneal shunt Ventriculoatrial shunt Ventriculoplural shunt

36. Complications of VP Shunt. Shunt Malfunctioning. Shunt block. Shunt Infection. Slit like