Pediatric emergency medicine trisk 4009 4009

Goals of Treatment
Hydrocephalus can present in an acute or subacute fashion. Most children
with hydrocephalus will need surgical treatment.
CLINICAL PEARLS AND PITFALLS
Hydrocephalus has been categorized as obstructive
(noncommunicating) or nonobstructive (communicating).
Most cases of pediatric hydrocephalus, even congenital, have a
delayed diagnosis.
Hydrocephalus is rarely a stand-alone diagnosis and is often
secondary to additional pathology.
Hydrocephalus is the excess accumulation of cerebrospinal fluid (CSF),
usually as the result of obstruction in CSF absorption, resulting in raised
ICP. CSF is produced by the choroid plexus which is located within all four
ventricles in the brain. Under normal conditions, the CSF exits the fourth
ventricle to circulate in the subarachnoid space to be absorbed back into the
venous system largely through arachnoid villi located at the superior sagittal
sinus. Obstructive (or noncommunicating) hydrocephalus does not allow for
the CSF to leave the ventricular system, and nonobstructive (or
communicating) hydrocephalus occurs when the obstruction to CSF
absorption lies outside the ventricular system in the subarachnoid space or
at the arachnoid villi.
Common causes of obstructive hydrocephalus include stenosis of the
cerebral aqueduct (from congenital causes, midbrain tumors, following
hemorrhage or infection) and posterior fossa tumors. Common causes of
nonobstructive hydrocephalus include scarring of the subarachnoid space
and arachnoid villi following intraventricular hemorrhage (IVH) in
premature infants or meningitis. In congenital conditions such
myelomeningocele, the cause of hydrocephalus is likely multifactorial and
may involve both obstructive and nonobstructive elements. Genetic causes
are a less likely cause, including X-linked aqueductal stenosis and primary
ciliopathies.