Edit concept Question Editor Create issue ticket

Obstructive Hydrocephalus

Hydrocephalus Noncommunicating

Hydrocephalus, defined as the accumulation of cerebrospinal fluid (CSF) in the brain, may occur in the setting of obstructed CSF flow throughout the ventricular system, in which case the term obstructive hydrocephalus is used. Signs and symptoms depend on the age of the patient and the underlying cause. A comprehensive clinical and imaging workup is necessary to make the diagnosis and determine the causes of CSF obstruction.


Presentation

Obstructive hydrocephalus is broadly defined as an abnormal accumulation of CSF in the brain due to obstruction of CSF flow [1] [2] [3]. The obstruction can occur at virtually any point of the CSF pathway, including the ventricular system (the lateral, 3rd and 4th ventricle, as well as the foramen of Monroe and the Sylvian aqueduct) and the subarachnoid space, and numerous etiologies have been established [2]. Intracranial hemorrhage (particularly in neonates and infants), infections (bacterial meningitis, but also intrauterine infections by toxoplasma gondii, cytomegalovirus and enteroviruses), and tumors are some of the more common causes, while progressive enlargement of the 4th ventricle (known as Dandy-Walker malformation), Arnold-Chiari malformation of the cerebellum, and a range of genetic disorders are also described as causative agents of obstructive hydrocephalus [2] [3] [4] [5]. In infants and neonates, a disproportionate head growth, bulging fontanelles, markedly wider separation of the cranial sutures, and paresis of upward gaze (the "setting sun" of the eyes) are typical signs of hydrocephalus that may be accompanied by poor feeding, irritability, and a delayed maturation [2] [3] [5]. On the other hand, headaches, vomiting, visual deficits, and drowsiness are encountered in adults and older children in the setting of hydrocephalus, whereas hypertension, bradycardia and respiratory difficulties signify severe obstruction of CSF flow [2] [4]. In addition to the acute symptomatology, hydrocephalus might also cause chronic symptoms, such as behavioral and cognitive changes, delayed puberty, and defects of higher brain functions [3] [4]. In either case, a prompt diagnosis could significantly reduce the risk for the patient, and might even be life-saving.

Hypersomnia
  • CASE DESCRIPTION: We describe a 30-year-old man who presented with complaints of headache, poor attention and concentration, forgetfulness, polyuria, urinary incontinence for past 3 years and hypersomnia for 3 months.[ncbi.nlm.nih.gov]
Abdominal Mass
  • At admission she presented with a subcutaneous infection of the shunt catheter and an abdominal mass of unknown etiology.[ncbi.nlm.nih.gov]
Heart Disease
  • METHOD: A 76-year-old woman with a cardiac pacemaker for an underlying heart disease was diagnosed with obstructive hydrocephalus because of a third ventricular tumor 8 years ago.[ncbi.nlm.nih.gov]
Macrocephaly
  • Progressive macrocephaly prompted an MRI confirming triventricular hydrocephalus secondary to aqueductal stenosis.[ncbi.nlm.nih.gov]
  • Serial enlargement of the lateral ventricles 1.5 mm/week and fetal macrocephaly were documented. Using epidural and GETA, a standard ultrasmall ventricular catheter and valve were inserted via a hysterotomy.[ncbi.nlm.nih.gov]
  • Before the bony sutures of the skull have fused in a child, hydrocephalus may present as progressive and abnormal enlargement of the head (macrocephaly).[casemed.case.edu]
  • Macrocephaly may result from an underlying brain problem (eg, Alexander disease or Canavan disease), or it may be a benign, sometimes inherited, feature characterized by an increased amount of CSF surrounding a normal brain.[msdmanuals.com]
Bulging Fontanelle
  • In infants and neonates, a disproportionate head growth, bulging fontanelles, markedly wider separation of the cranial sutures, and paresis of upward gaze (the "setting sun" of the eyes) are typical signs of hydrocephalus that may be accompanied by poor[symptoma.com]
  • If the disorder occurs before the cranial sutures have fused, the head may be enlarged, with bulging fontanelles.[msdmanuals.com]
Clumsiness
  • This 9-year-old boy, who had undergone chemotherapy for skin and lung LCH without central nervous system involvement at the age of 10 months, presented with acute ataxia, headaches, and paraparesis and a 1-year history of gradually increasing clumsiness[ncbi.nlm.nih.gov]
Quadriplegia
  • "Locked-in syndrome" is a clinical state characterized by quadriplegia and anarthria with preserved consciousness, most commonly caused by ischemia in the ventral part of pons.[ncbi.nlm.nih.gov]

Workup

Because hydrocephalus may lead to both short-term and long-term disability, early recognition is vital. Physicians should obtain a detailed patient history that will reveal when did the symptoms start and how did they progress, which is particularly important in neonates and younger children. If the physical examination reveals prominent cranial changes and detect respiratory, but also cardiac abnormalities, a valid clinical suspicion toward hydrocephalus as the underlying cause of symptoms can be made. Imaging studies, however, are the cornerstone in confirming hydrocephalus and the exact type, but also in identifying the condition that induced it. Because of its accessibility, non-invasiveness, and reliability in the youngest population with an open fontanelle, ultrasonography should be readily used in neonates, as it provides a direct view of the ventricular system and reveals the presence of a mass (eg. hematoma) that obstructs normal CSF flow [2] [4]. Otherwise, computed tomography (CT) and magnetic resonance imaging (MRI) are recommended during the diagnostic workup [1] [3] [4] [6]. Some of the most common features encountered in these studies are ventricular dilation and edema of the periventricular white matter (as a result of spinal fluid resorption), but their ability to confirm the exact location of the obstructive lesion is vital for both diagnostic and therapeutic purposes [2] [3] [6]. Additionally, diffuse-weighted (DW) MRI imaging has proven to be of even greater benefit when patients are suspected to suffer from hydrocephalus, and this technique should be employed whenever possible [6].

Cryptococcus Antigen
  • The diagnosis of cryptococcal meningitis was obtained later on by simultaneous plasma and CSF Cryptococcus antigen detection. Cryptococcus neoformans (formerly C. neoformans var. grubii [serotype A]) was then identified by PCR.[ncbi.nlm.nih.gov]

Treatment

  • Sequelae are disabling for patients and lead to a greater demand for healthcare infrastructure and search for treatment options.[ncbi.nlm.nih.gov]
  • OBSTRUCTIVE: hydrocephalus due to giant basilar artery (BA) aneurysm is a rare finding, and endoscopic treatment has not been reported.[ncbi.nlm.nih.gov]
  • Subsequent medical treatment led to progressive and marked shrinkage of the tumor.[ncbi.nlm.nih.gov]
  • We also discuss the treatment options in such cases.[ncbi.nlm.nih.gov]
  • The treatment of Pseudomonas infection requires prompt medical evaluation and appropriate antibiotic treatment. We report the case of a 6-month-old boy with an unusual presentation of acute obstructive hydrocephalus owing to Pseudomonas meningitis.[ncbi.nlm.nih.gov]

Prognosis

  • Acute cerebellitis is a rare entity, described in the pediatric population, usually of viral or autoimmune origin, bilateral and symmetric, and with good prognosis. Only 13 cases of unilateral cerebellitis have been reported thus far.[ncbi.nlm.nih.gov]
  • Correct interpretation and classification of the findings may be helpful in predicting prognosis and outcome.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Dilatation of VRS may produce multicystic giant lesions that can easily be confused with other pathologic condition that have a completely different prognosis and management.[ncbi.nlm.nih.gov]
  • We assessed epidemiology, clinical and imaging findings, neurosurgical management, and prognosis of adult patients with posterior fossa metastasis-associated obstructive hydrocephalus.[ncbi.nlm.nih.gov]
  • Rapid diagnosis and treatment is crucial to the prognosis.[ncbi.nlm.nih.gov]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Cortico-striatal-thalamic-cortical pathways, physically distorted by hydrocephalus in this case, have long been implicated in OCD etiology.[ncbi.nlm.nih.gov]
  • A larger longitudinal study considering the impact of prior shunting, presence of headaches, emotional status, and surgical complications will assist in elucidating the etiology and eventual treatment of these deficits.[ncbi.nlm.nih.gov]
  • At admission she presented with a subcutaneous infection of the shunt catheter and an abdominal mass of unknown etiology.[ncbi.nlm.nih.gov]
  • The etiology of hydrocephalus was congenital aqueduct stenosis in 11 patients, posthemorrhagic obstruction in six patients, myelomeningocele in two patients, postmeningitis in two patients, Chiari I malformation in one patients, and Dandy walker variant[ncbi.nlm.nih.gov]

Epidemiology

  • We assessed epidemiology, clinical and imaging findings, neurosurgical management, and prognosis of adult patients with posterior fossa metastasis-associated obstructive hydrocephalus.[ncbi.nlm.nih.gov]
  • Neurology and Neurosurgery Czech and Slovak Ophthalmology Czech and Slovak Psychiatry Czech Geriatric Review Czech Gynaecology Czech Rheumatology Czech Dental Journal Czech Urology Czech-Slovak Dermatology Czecho-Slovak Pathology Czech-Slovak Pediatrics Epidemiology[prolekare.cz]
  • Epidemiology There is some evidence that the incidence of paediatric hydrocephalus has declined in many developed countries.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • We discuss the pathophysiological mechanism of this complication.[ncbi.nlm.nih.gov]
  • Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York, NY: McGraw-Hill Medical; 2008:1744. 3. Kandasamy J, Jenkinson MD, Mallucci CL. Contemporary management and recent advances in paediatric hydrocephalus. BMJ. 2011;343:146-151. 4.[uspharmacist.com]

Prevention

  • Bilateral neurological symptoms suggest diffuse axonal damage and normalization of the intracranial pressure should be performed on the early onset of clinical detorioration in order to prevent axonal injury.[ncbi.nlm.nih.gov]
  • Knowledge about the existence of such an entity and their radiologic features is important to prevent such misdiagnosis and mismanagement in the form of biopsy/excision, which can have devastating consequences. Copyright 2015 Elsevier Inc.[ncbi.nlm.nih.gov]
  • In most of the symptomatic patients with obstructive hydrocephalus, lumbar puncture appears to contribute to rapid ICP normalization, to alleviation of symptoms, and prevention of complications. Georg Thieme Verlag KG Stuttgart · New York.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The dual-channel endoscopic port facilitated bimanual refinement microsurgery during the evacuation of deep-seated intracerebral hematomas, and it prevented the disturbance of the 3 instruments without restraining the scope of the operation[ncbi.nlm.nih.gov]
  • Potential advantages include avoiding or reducing duration of EVD placement and preventing ventriculoperitoneal shunt placement.[ncbi.nlm.nih.gov]

References

Article

  1. Kartal MG, Algin O. Evaluation of hydrocephalus and other cerebrospinal fluid disorders with MRI: An update. Insights Imaging. 2014;5(4):531-541.
  2. Venkataramana NK. Hydrocephalus Indian scenario – A review. Journal of Pediatric Neurosciences. 2011;6(Suppl1):S11-S22.
  3. Tully HM, Dobyns WB. Infantile hydrocephalus: a review of epidemiology, classification and causes. Eur J Med Genet. 2014;57(8):359-368.
  4. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  5. Aster, JC, Abbas, AK, Robbins, SL, Kumar, V. Robbins basic pathology. Ninth edition. Philadelphia, PA: Elsevier Saunders; 2013
  6. Uluğ AM, Truong TN, Filippi CG, et al. Diffusion imaging in obstructive hydrocephalus. AJNR Am J Neuroradiol. 2003;24(6):1171-1176.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-06-28 10:07