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.

• Collapse

  He had collapsed at home, and his parents reported that for three days he had had fever, anorexia, vomiting, and increasing drowsiness. On arrival at hospital he was poorly perfused, could barely be roused, and his anterior fontanelle was bulging. [bmj.com]

  The aqueduct and the fourth ventricle are collapsed. Often, there is aqueductal atresia. The foramina of Luschka lie in the spinal canal, and the subarachnoid space around them is collapsed and fibrotic. [neuropathology-web.org]

  Even after appropriate placement of a shunt, annual neurologic visits are required. 11 Complications, including shunt collapse, infection, and occlusions, can cause a rise in CSF pressure that may lead to symptom recurrence and the need for additional [uspharmacist.com]

  Overdraining can cause the ventricles to collapse, tearing blood vessels and causing headache, hemorrhage (subdural hematoma), or slit-like ventricles (slit ventricle syndrome). [ninds.nih.gov]

  Overdraining can cause the ventricles to collapse, tearing blood vessels and causing headache, hemorrhage (subdural hematoma ), or slit-like ventricles (slit ventricle syndrome). [medicinenet.com]

• Cerebral Palsy

  Beyond this point, there continues to be a small risk of complications from early delivery including cerebral palsy, intraventricular hemorrhage, necrotizing enterocolitis and respiratory distress syndrome. [chop.edu]

• Projectile Vomiting

  The patient presented to the emergency department at the authors' institution with a 1-day history of projectile vomiting, lethargy, and dysconjugate gaze. Hydrocephalus was confirmed on head CT. [ncbi.nlm.nih.gov]

• Diplopia

  A 46-year-old man developed intermittent headache, diplopia, and visual obscuration for two months. Funduscopic examination showed optic disk swelling in both eyes. [ncbi.nlm.nih.gov]

  On physical exam, the patient had normal mental status but had difficulty with tandem gait, truncal ataxia, and mild left sixth nerve palsy with diplopia. [cureus.com]

• Esotropia

  Children present with headache, vomiting, lethargy, irritability, esotropia, or paralysis of upward gaze. Seizures may occur. [msdmanuals.com]

• Macrocephaly

  Progressive macrocephaly prompted an MRI confirming triventricular hydrocephalus secondary to aqueductal stenosis. [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]

• Contusion

  One clinically silent fornix contusion and one CSF fistula which was treated conservatively occurred. There was no permanent morbidity. CONCLUSIONS: ETV is a successful treatment option in CSF pathway obstructions distal to the fourth ventricle. [ncbi.nlm.nih.gov]

• Facial Numbness

  The patient reported transient facial numbness postoperatively but had a steady improvement of cognitive function with a return to baseline function within three months. [cureus.com]

• Papilledema

  A 40-year-old African American man presented with papilledema, diplopia, and headache. Magnetic resonance imaging revealed "aqueductal stenosis" without abnormal enhancement or obstructive lesion. [ncbi.nlm.nih.gov]

  […] children and adults include the following: Slowing of mental capacity, cognitive deterioration Headaches (initially in the morning) Neck pain, suggesting tonsillar herniation Vomiting, more significant in the morning Blurred vision: A consequence of papilledema [emedicine.medscape.com]

  Papilledema may be evident 2. In children whose cranial sutures have yet to fuse, there is a rapid enlargement of the head circumference 2. [radiopaedia.org]

  Signs and symptoms of hydrocephalus include emesis (especially in the morning), decline in cognitive ability, headaches, papilledema, ataxia and defect in upward gaze. Infant with hydrocephalus Case 3: Imaging findings: Figure 3. [stritch.luc.edu]

  This finding is called papilledema and can be found on a careful eye examination. If obstructive hydrocephalus is caused by a tumor or other mass, the patient may present with other neurological symptoms which are associated with the tumor itself. [nervous-system-diseases.com]

• Intracranial Hemorrhage

  Nevertheless, it is seldom considered in intracranial hemorrhage even in cases involving obstruction of the CSF circulation. [ncbi.nlm.nih.gov]

  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 [symptoma.com]

  Intracranial hemorrhage after spine surgery. J Neurosurg Spine 2013;19:370-80. 16. Khalatbari MR, Khalatbari I, Moharamzad Y. Intracranial hemorrhage following lumbar spine surgery. Eur Spine J 2012;21:2091-6. 17. Brockmann MA, Groden C. [asianjns.org]

  Hydrocephalus that results from head trauma, brain tumors, intracranial hemorrhage, or meningitis. The abnormal buildup of cerebrospinal fluid in the ventricles of the brain. [icd10data.com]

• Bulging Fontanelle

  If the disorder occurs before the cranial sutures have fused, the head may be enlarged, with bulging fontanelles. [msdmanuals.com]

  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]

  and a pre-bulged forehead. [uniklinik-freiburg.de]

  Diagnosis Examination in infants may reveal the following findings: Head enlargement (head circumference ≥98th percentile for age), especially crossing percentiles on the growth chart Dysjunction/splaying of sutures Dilated scalp veins Tense/bulging fontanelle [emedicine.medscape.com]

  Bulging of the fontanelles, or the soft spots between the skull bones, may also be an early sign. When hydrocephalus occurs in infants, fusion of the skull bones is prevented. This leads to abnormal expansion of the skull. [encyclopedia.com]

• Cognitive Impairment

  Case Presentation A 36-year-old previously healthy male presented with a three-month history of progressive headaches, dizziness, loss of balance, decreased sleep, and cognitive impairment with psychosocial problems. [cureus.com]

  Cognitive impairments after surgical repair of ruptured and unruptured aneurysms. J Neurol Neurosurg Psychiatry. 2000. 69: 608-15 9. Hirsch JF, Hirsch E, Sainte Rose C, Renier D, Pierre-Khan A. Stenosis of the aqueduct of Sylvius. [surgicalneurologyint.com]

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].

OBSTRUCTIVE: hydrocephalus due to giant basilar artery (BA) aneurysm is a rare finding, and endoscopic treatment has not been reported. [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]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

The diagnosis of hydrocephalus is not a challenge presently, but the exact definition of this entity and its etiology is often difficult. Early detection of the etiology o f hydrocephalus is vital for accurate and early treatment. [content.iospress.com]

At admission she presented with a subcutaneous infection of the shunt catheter and an abdominal mass of unknown etiology. [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]

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]

Estimating mortality from tuberculous meningitis in a community: Use of available epidemiological parameters in the Indian context. Indian J Tub 2000;47:9-12. 2. Tandon PN. Tuberculous meningitis (cranial and spinal). [neurologyindia.com]

We discuss the pathophysiological mechanism of this complication. [ncbi.nlm.nih.gov]

Although hydrocephalus is typically referred to as either being "obstructive" or "communicating", this can lead to confusion as to the underlying cause of ventriculomegaly as the terms are referring to different aspects of the underlying pathophysiology [radiopaedia.org]

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]

We comment on the possible pathophysiological mechanisms that may result in this dissociation in ventricular and lumbar CSF composition. Conclusions. [scielo.isciii.es]

ICH, a rare but potentially fatal complication after spinal surgery, is known to be associated with excessive CSF loss. [14], [15], [16] The postulated pathophysiology of ICH is that an increase in the transluminal venous pressure or downward cerebellar [asianjns.org]

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]

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.