Friday, December 31, 2010

Hydrocephaly and What it Tells us About the Potential of the Human Mind

What is hydrocephaly?

Hydrocephaly or hydrocephalus - also known as ‘water on the brain’ is a brain disease that affects 1 in every 500 births, making it one of the most common developmental disabilities - more common than Down syndrome or deafness. It was first described by Hippocrates, the ancient Greek physician. It wasn’t until the 20th century that effective treatments were developed for it, and there is still no known cure.

So what is it?

Our brains are suspended in a bath of fluid called cerebrospinal fluid. In hydrocephaly, pockets of this fluid in the brain called ventricles expand like balloons, pushing into the brain tissue. It can cause convulsions, mental retardation and death. In the worst cases 95% of the skull is filled with cerebrospinal fluid and all that is left of the normal 1.5kg brain is a thin layer of 50-100g rind pressed up against the skull.

The British neurologist John Lorber documented over 600 scans of people with hydrocephaly, and he made an extraordinary discovery. Among those in the most severe category of 95% or more fluid, half were severely retarded. But the other half were found to have IQ’s greater than 100. One young man in the category of ‘virtually no brain whatsoever’ was recorded to have an IQ of 126. He got a first class honors degree in mathematics.

But in point of fact this 44 year old French man was living a normal life. “He was a married father of 2 children, and worked as a civil servant,” Dr Lionel Feuillet and colleagues at the Universite de la Mediterranee in Marseille wrote in a letter to the The Lancet medical journal.
What explains hydrocephaly? Brain plasticity?

Brain plasticity is the ability of the brain to reorganize itself – forming new brain cells and connections and new functions for brain cells (neurons). Brain plasticity is adaptive – enhancing function, or compensation for lost function. The jury is now in that the brain is capable of remarkable widespread growth and adaptation throughout the lifespan – not just in childhood.

Brain plasticity comes into play whenever we form a new long-term memory, learn something new or develop a new skill, new neurons and new brain circuitry comes with it. With each new skill grows a new network of brain tissue. Cortical hemispheres change their circuitry with long term meditation practice. Focal points of cortex expand as you learn a new musical instrument.

Many neurologists feel that these extraordinary cases of hydrocephaly are a tribute to the brain's incredible plasticity. Does brain plasticity explain hydrocephaly?

In a sense brain plasticity is obviously at work here. Obviously these people’s brains have reorganized themselves massively – almost beyond recognition. But are the principles of this re-organization understood? The answer is no. While growing extra neural connection strengths or new neurons as a result of learning can be explained in terms of brain plasticity, the kind of colossal transformation we here goes far beyond what fits comfortably into standard scientific theories about brain function.

Patrick Wall, professor of anatomy at University College, London believes that talking as though these cases are explained by the brain’s plasticity “ is a cop-out to get around something you don't understand”. I’m with him.
Hydrocephaly and the potential of the human mind.

In my view, hydrocephaly shows us that our MINDS can determine the neurobiology of our brains. By this I mean that these remarkable individuals with almost no brains are best understood by figuring out how mental causes cause and re-organize brain processes – rather than our usual way of thinking about it: that brain processes determine our mental life. The fact that these individuals with only a small fraction of the normal amount of brain tissue have normal or exceptional minds defies conventional neuroscientific explanations of behaviour. Getting an honors degree in mathematics with a 50 gram brain can only be explained if we accept that mental life in some important sense transcends our biological life: there must be emergent properties that are fully MENTAL which end up rewiring the brain in ways that defy our current scientific understanding.

Many of these individuals describe themselves as strong-willed and stubborn. I am going to propose a hypothesis: EVERY SINGLE ONE of these cases we have looked at has a strong mind. They are determined, stubborn, focused. If they took personality tests, these qualities would be revealed. They have minds that defy the odds. With a strong and determined mind, individuals with hydrocephaly prove that you only need a brain the weight of a large coin to get a first class honors degree in mathematics! Imagine what is possible with a strong mind and a 1.5kg brain like most of us have?

Hydrocephalus Baby

Thursday, December 30, 2010

Abnormalities in a Child's physical development

Most of the disorders a Child experiences after birth are congenital, that means they were acquired at the time of birth or maybe due to some metabolic malfunctions or nutrient deficiencies during pregnancy. Expectant mothers have to know these deficiencies and take adequate precaution by seeking for advice from their doctors to know the exact kind of lifestyle to live in order to welcome their babies in good health.

The main disorders of children's physical development are;• Hypotrophy• Paratrophy• Obesity• Nanism (dwarfism)• Small stature• Gigantism• Hydrocephalus• Microcephalus
HypotrophyIt is delayed physical development of a child of first 2 years of Life mainly due to deficiency of real weight in comparison to ideal weight. Hypotrophy can be congenital, acquired or mixed.

Congenital Hypotrophy must be diagnosed immediately after child's birth. Informative index for this is weight-length coefficient (WLC).WLC= weight of newborn (g)/Length of newborn (cm)Normal WLC is 60-64With the WLC index, stages of hypotrophy can be established.1st stage, WLC=59-562nd stage, WLC=55-503rd stage, WLC=49 and less.
If the deficiency of body weight is observed on the 2nd month of child's life and later, the hypotrophy is acquired. There are 3 stages of acquired hypotrophy depending on the stage of weight deficiency;1st stage; 11-20 (%)2nd stage, 21-30 (%)3rd stage, 31 and more
The clinical signs of hypotrophy are the decrease of subcutaneous fat on abdomen (at the 1st stage), on extremities (at the 2nd stage), on the face (at the 3rd stage). At the 3rd stage of hypotrophy, the child's face looks like the face of Old man ("Volter's face"). Besides this, the decrease of skin elasticity, turgur and body length, delay of neuropsychological development and weakness of immune system take place.

In case, when the child was born with hypotrophy and the body weight does not normalize during some first months of his (her) life, the hypotrophy is of mixed genesis.
ParatrophyIt is enlargement of body weight more than for 10% of ideal weight. The main course of it is overfeeding of a baby.1st stage, 11-20 (%)2nd stage, 21-30 (%)3rd stage, 31 and more.
ObesityThe presence of excessive weight in child older than 1 year is called obesity.1st stage, 10-29 (%)2nd stage, 30-49 (%)3rd stage, 50-99 (%)4th stage, 100 and more
Nanism (dwarfism)It is a disorder of physical development, which deals with the delay of height. The dwarf Nanism is congenital disorders of endocrine system hypofunctions of hypophysis or thyroid) or metabolism. The main symptom of dwarfism is delay of growth in height. Late symptoms of dwarfism are dry, wrinkled and pale skin, childish face, poorly developed muscles, excessive development of subcutaneous fat on the chest (pseudo mammas), low blood pressure.
Small statureIt is the equal delay of height and weight gain in children in comparison to the average data. Etiology of small stature is heredity, lack of protein and vitamins intake during prenatal period and the 1st year of Life.

GigantismIt's a clinical syndrome, which develops as a result of hyper-production of somato-tropine hormone of hypophysis that leads to remarkable growth in height.
The first manifestation of gigantism takes place during pre-pubertal or pubertal periods. Other complaints are weakness, often headaches, extremity or cardiac pains. Physical development of such children is disproportional.

Do not worry if you encounter any of these ailments. They could easily be treated.

Acquired Hydrocephalus and Increased Intracranial Tension

It is caused by subarachnoid hemorrhage, Basal meningitis and Neoplasms obstructing the aqueduct. The basal foramina may be obstructed in meningitis and subarachnoid hemorrhage. The skull is not enlarged if hydrocephalus occurs after closure of the fontanelles. Rise of intracranial tension leads to radiological features such as resorption of the cliniod processes and thining of the skull vault giving rise to a 'silver beaten' appearance.

Increased intracranial Tension
Persistent increase in tension of CSF above 120 mm CSF (or water) in the recumbent posture constitutes raised intracranial tension (ICT). The normal contents of the cranium are the nervous tissue, cicrculating blood and CSF. Rise in intracranial tension may result from increase in the contents of the cranium. E.g, clots, tumors, abscesses or edema of the brain or due to obstruction to the flow of CSF into the subarachnoid space to be absorbed by the arachnoid granulations. Some degree of compensation is possible to normalize the intracranial tension in health and disease. These mechanisms include:
1. displacement of CSF from the cranium and
2. drainage of blood by the emissary veins.

When rise of intracranial tension proceeds, these compensatory mechanisms are overcome. Rise in intracranial tension leads to disturbances of hypothalamic vasomotor regulatory mechanisms. These lead to the development of bradycardia and systolic hypertension (Cushing's vasomotor phenomena). Further rise in tension results in displacement of the brain. If the rise in tension is caused by a unilateral lesion in the brain, the ipsilateral hemisphere is pushed to the opposite side under the falx cerebri-subfalcine herniation. The medial part of the temporal lobe is pushed down through the tentorial hiatus-transtentorial herniation. This gives rise to paralysis of the third nerve. Pressure of the ipsilateral cerebral peduncles gives rise to contralateral hemiparesis. Contre-coup pressure on the opposite cerebral peduncle by the free margin or the tentorium cerebelli gives rise to hemiparesis of the ipsilateral side as well. As the tension increases further, both the pupils dilate, both the cerebral peduncles are compressed and the picture is one of decerebrate rigidity. Opistotonic seizures may develop. When the intracranial tension reaches that of arterial blood pressure, cerebral blood flow is considerably diminished. Medullary centres are dp[ressed. The cerebellar tonsils herniated down the foramen magnum compressing the medulla and this leads to respiratory paralysis and death. Lesions in the posterior cranial fossa give rise to ICT earlier than supratentorial lesions.

Clinical features
Headache: Early symptom is headache, which is dull initially and it tends to worsen in the mornings. Later it becomes persistent and assumes a bursting character. Sharp rise in intracranial tension caused by coughing, straining at stools or stooping forwards gives rise to aggravation of the headache. Later the headache may become so severe and constant that the patient may not even complain of it unless specifically asked for.

Vomiting: Stimulation of mid-line structures in the medulla (Vomiting center) gives rise to effortless and projectile vomiting. In projectile vomiting nausea is usually absent.

Loss of vision: As the ICT rises, vision deteriorates. Defects in the visual fields, diplopia, and total blindness may follow. Fundus-copy shows papilledema and later on, optic atrophy.

Mental changes: These include apathy, abnormal behavior and lack of attention to personal details. With further rise in ICT the patient may become comatose.

Seizures: These may be the presenting symptom in many. These may be generalized motor, focal, complex, sensory or psychomotor in type.

Focal neurological deficits: These depend upon the location of the primary lesion. These may take the form of irritative phenomena like focal seizures, paralysis or disturbance of higher functions.

Hypothalamic disturbances: Endocrine disturbances develop in longstanding cases whereas the rise in ICT is gradual and prolonged. These may result in disturbances of the hypothalamus, pituitary or both. Symptoms include amenorrhea, precocious puberty, obesity, gigantism, somnolence, and hyperphagia.
In children, constipation is frequent and this results from the fear to defecate since the act of defecation causes rapid worsening of the headache.

Common causes of raised ICT
1. Space occupying lesions: Tumors, abscess, granulomas, cysts
2. Inflammation: Meningitis, encephalitis, cerebral edema
3. Vascular accidents: Cerebral and subarachnoid hemorrhage, thromboembolic episodes giving rise to cerebral edema, cerebral venous thrombosis.
4. Obstruction to flow of CSF
5. Miscellaneous causes: Systemic hypertension, especially malignant hypertension; chronic respiratory failure, water, intoxication.

Investigation: Apart from general investigations to exclude systemic disorders, specific investigations include radiological studies, electroencephalography, CT scanning, isotope studies, and CSF examination. It is to be remembered that lumbar puncture is a risky procedure in the presence of raised ICT and this should not be performed without neurological assistance.

General measures
Osmotic agents: Administration of mannitol 20% solution 300 ml as a intravenous drip within 30 minutes, helps to draw fluid from the brain and transfer it to the vascular compartment. This leads to a temporary fall in ICT. Other hyperosmotic solutions such as 50% sucrose (50 ml) and 20% Urea (200 ml) also act on the same principle but they are less efficient. Dexamethasone in a dose of 8-12 mb given intramuscularly every 6 hours also serves to lower ICT.

Specific management: Treatment of the cause relieves the raised ICT also. Surgical measures may be required in many cases.

Hydrocephalus Awareness

Hydrocephalus

Hydrocephalus is a condition that occurs when there is too much cerebrospinal fluid in the ventricles (cavities) of the brain. Cerebrospinal fluid (CSF) is produced in the brain, and is needed by the body to protect the brain and spinal cord, and carry away waste from brain cells. It flows continuously through the ventricles of the brain and over the surface of the brain and spinal cord. Any excess CSF usually drains away from the brain and is absorbed by the body. For people with hydrocephalus, this doesn't happen, and the fluid instead builds up in the ventricles. In United State incidence of congenital hydrocephalus is 3 per 1,000 live births. There are two kinds of hydrocephalus.

Congenital hydrocephalus is present at birth. Causes include genetic problems and problems with how the fetus develops. An unusually large head is the main sign of congenital hydrocephalus. Acquired hydrocephalus can occur at any age. Causes can include head injuries, strokes, infections, tumors and bleeding in the brain. Other possible causes comprise complications of early birth such as intraventricular hemorrhage, diseases such as meningitis, tumors, traumatic head injury, or subarachnoid hemorrhage, which block the exit of CSF from the ventricles to the cisterns or remove the passageway for CSF into the cisterns.

The signs and symptoms of hydrocephalus vary by age group and disease progression. Symptoms of increased intracranial pressure may include headaches, vomiting, nausea, papilledema, sleepiness, or coma. In infancy, the most obvious indication of hydrocephalus is often a rapid increase in head circumference or an unusually large head size. Other symptoms may include irritability, downward deviation of the eyes (also called "sunsetting"), and seizures. Elevated intracranial pressure may effect in uncal and/or cerebellar tonsill herniation, with ensuing life threatening brain stem compression. For details on other manifestations of increased intracranial pressure.

Treatment usually involves surgery to insert a shunt. This system diverts the flow of CSF from the CNS to another area of the body where it can be absorbed as part of the normal circulatory process. A shunt is a flexible but sturdy plastic tube. A shunt system consists of the shunt, a catheter, and a valve. One end of the catheter is placed within a ventricle inside the brain or in the CSF outside the spinal cord. The other end of the catheter is commonly placed within the abdominal cavity. Medicine and rehabilitation therapy can also assist. Another surgical choice ventriculostomy is sometimes used when there's an obstruction of flow between ventricles.

Wednesday, December 29, 2010

Hydrocephalus Shunt Procedures

Shunt surgery is a relatively short and uncomp>licated procedure that varies slightly depending upon two factors : -

* The neurosurgeon's preference on where to place the upper shunt catheter
* The decided location of the lower shunt catheter to permit draining of the excess cerebrospinal fluid (CSF)



When it is time for your surgery, you will be brought into the operating room. There, you will be hooked up to an intravenous (IV) line as well as to one or more devices to monitor you during and after surgery. These devices include : -

* Electrocardiogram (EKG -which monitors your heart rate.
* Automatic blood pressure (BP) cuff-monitors your blood pressure.
* Pulse oximeter-measures the amount of oxygen in your blood.


The surgical procedure to implant a VP (ventricular peritoneal) shunt usually requires less than an hour in the operating room.
After the patient is placed under general anesthesia, their scalp is shaved and the patient is scrubbed with an antiseptic from the scalp to the abdominal area. These steps are taken in order to reduce the chances of an infection. Incisions are then made on the head and in the abdomen to allow the neurosurgeon to pass the shunt's tubing through the fatty tissue just under the skin. A small hole is made in the skull, opening the membranes between the skull and brain to allow the ventricular end of the shunt to be passed through the brain and into the lateral ventricle. The abdominal (peritoneal) end is passed into the abdominal cavity through a small opening in the lining of the abdomen where the excess CSF will eventually be absorbed. The incisions are then closed and sterile bandages are applied.


Tube-shunt surgery, or Seton tube shunt glaucoma surgery, is a surgical method to treat glaucoma. Glaucoma is a potentially blinding disease affecting 2-3% of the United States population. The major known cause of glaucoma is a relative increase in intraocular pressure, or IOP. The purpose of glaucoma treatment, whether medical or surgical, is to lower the IOP.

Aqueous fluid is made continuously, and circulates throughout the eye before draining though channels in the eye's anterior chamber. When too much fluid is made, or it is not drained sufficiently, the IOP rises. This fluid build-up can lead to glaucoma. Normal intraocular pressure is under 21 mm/Hg. Glaucoma develops at IOPs higher than 21mm/Hg. However, approximately 20% of glaucoma patients never have pressures higher than 21 mm/Hg.

The surgical procedure to implant a VP (ventricular peritoneal) shunt usually requires less than an hour in the operating room. After the patient is placed under general anesthesia, their scalp is shaved and the patient is scrubbed with an antiseptic from the scalp to the abdominal area. These steps are taken in order to reduce the chances of an infection. Incisions are then made on the head and in the abdomen to allow the neurosurgeon to pass the shunt's tubing through the fatty tissue just under the skin. A small hole is made in the skull, opening the membranes between the skull and brain to allow the ventricular end of the shunt to be passed through the brain and into the lateral ventricle. The abdominal (peritoneal) end is passed into the abdominal cavity through a small opening in the lining of the abdomen where the excess CSF will eventually be absorbed. The incisions are then closed and sterile bandages are applied.


After surgery

The patient generally stays under careful neurological observation for the first 24 hours following the procedure. Some neurosurgeons prefer to keep the patient flat in bed until nearly all the subdural air introduced during surgery dissipates. The bandages placed on the head and abdomen, covering the incision sites, are monitored for signs of infection. The patient will generally need to stay in the hospital from three to seven days. Follow-up visits will be necessary to check post-operative status and resolution of symptoms. Additional treatment, such as physical therapy, may be advised to help the patient attain previous levels of motor skills.

Speech on Hydrocephalus

Hydrocephalus – Causes, Symptoms and Treatment

Hydrocephalus is a condition in which there is too much CSF in the ventricles. This occurs when the natural system for draining and absorbing extra CSF does not work right. The ventricles enlarge to accommodate the extra fluid and then press on different parts of the brain, causing a number of different symptoms. Hydrocephalus has many different causes. Some people are born with the condition, while others develop it during their lives.

Causes

Possible etiologic factors include head injury, subarachnoid hemorrhage, meningitis, and CNS tumor. Although each of these conditions may cause hydrocephalus, how they are related to subsequent NPH is unclear.

Hydrocephalus is usually the result of a brain infection or a malformation in the fetus prior to birth. Although the baby's head may not appear abnormally large at birth, it expands rapidly from month to month. If untreated, the baby usually dies by the end of the second year. If the blockage of CSF is only partial, the child may live for a number of years or may even live a normal life span.
Hydrocephalus is due to a problem with the flow of cerebrospinal fluid (CSF), the liquid that surrounds the brain and spinal cord.CSF moves through pathways of the brain called ventricles. It also flows around the outside of the brain and through the spinal canal. Higher-than-normal amounts of CSF can occur in the brain if the flow or absorption of CSF is blocked, or if too much CSF is produced. The build up of fluid puts pressure on the brain, pushing the brain up against the skull and damaging or destroying brain tissues.

Symptoms

Symptoms of hydrocephalus recur after successful ventriculoperitoneal (V-P) shunt placement, shunt malfunction should be suspected and evaluation for mechanical failure pursued. Catheter migration should be recognized as a correctable cause of shunt malfunction.

Hydrocephalus symptoms vary with age, disease progression, and a person's tolerance to cerebrospinal fluid (CSF). For example, an infant's ability to tolerate CSF pressure differs from an adult's. The infant skull can expand to accommodate the buildup of CSF because the sutures (the fibrous joints that connect the bones of the skull) have not yet closed.

A large head that may get bigger very quickly. Usually a baby with congenital hydrocephalus will have a noticeably bigger head than other babies the same age. A slightly bulging soft spot (fontanelle) on top of the head that doesn't go away when the baby is held upright. A baby may also have larger-than-normal areas between the skull bones.

Treatment

Surgical correction is the only treatment for hydrocephalus. Usually, such surgery consists of insertion of a ventriculoperitoneal shunt, which transports excess fluid from the lateral ventricle into the peritoneal cavity. A less common procedure is insertion of a ventriculoatrial shunt, which drains fluid from the brain's lateral ventricle into the right atrium of the heart, where the fluid makes its way into the venous circulation. Periodic lengthening of the shunt is necessary to accommodate growth in children. A clogged malfunctioning shunt will have to be replaced.

Hydrocephalus can pose risks to both mental and physical development. Many children diagnosed with the disorder benefit from rehabilitation and educational programs, and go on to lead normal lives. Don't be afraid to ask your doctors, nurses or therapists about the treatments your child will receive. If treatment includes medication, be sure your child takes it exactly as your doctor has ordered. And remember to bring your child to all follow-up appointments requested by our doctors or other medical staff.

Tuesday, December 28, 2010

Hien & The Hydrocephalus

What is Hydrocephalus?

Hydrocephalus can be defined broadly as a disturbance of formation, flow, or absorption of cerebrospinal fluid (CSF) that leads to an increase in volume occupied by this fluid in the central nervous system (CNS). This condition also could be termed a hydrodynamic disorder of CSF. Acute hydrocephalus occurs over days, subacute over weeks, and chronic over months or years. Conditions such as cerebral atrophy and focal destructive lesions also lead to an abnormal increase of CSF in CNS. In these situations, loss of cerebral tissue leaves a vacant space that is filled passively with CSF.

The ventricular system is made up of four ventricles connected by narrow passages.. Normally, CSF flows through the ventricles, exits into cisterns (closed spaces that serve as reservoirs) at the base of the brain, bathes the surfaces of the brain and spinal cord, and then reabsorbs into the bloodstream. CSF has three important life-sustaining functions: 1) to keep the brain tissue buoyant, acting as a cushion or "shock absorber"; 2) to act as the vehicle for delivering nutrients to the brain and removing waste; and 3) to flow between the cranium and spine and compensate for changes in intracranial blood volume (the amount of blood within the brain).

The causes of hydrocephalus are still not well understood. Hydrocephalus may result from inherited genetic abnormalities (such as the genetic defect that causes aqueductal stenosis) or developmental disorders (such as those associated with neural tube defects including spina bifida and encephalocele). Other possible causes include complications of premature birth such as intraventricular hemorrhage, diseases such as meningitis, tumors, traumatic head injury, or subarachnoid hemorrhage, which block the exit of CSF from the ventricles to the cisterns or eliminate the passageway for CSF into the cisterns.

Symptoms of hydrocephalus vary with age, disease progression, and individual differences in tolerance to CSF. In infancy, the most obvious indication of hydrocephalus is often the rapid increase in head circumstance or an unusually large head size. In older children and adults, symptoms may include headache followed by vomiting, nausea, papilledema (swelling of the optic disk, which is part of the optic nerve), downward deviation of the eyes (called "sunsetting"), problems with balance, poor coordination, gait disturbance, urinary incontinence, slowing or loss of development (in children), lethargy, drowsiness, irritability, or other changes in personality or cognition, including memory loss.

Normal flow and absorption through the subarachnoid space is dependent on proper CSF pressure in the head (called intracranial pressure). A build up of CSF often causes a dangerous increase in pressure. The combination of CSF buildup and the subsequent increase in intracranial pressure can stress brain tissue and can cause the characteristic symptoms of hydrocephalus, though they also may occur with normal pressure.

Hydrocephalus produces different combinations of these signs and symptoms, depending on its cause, which also varies by age. For example, a condition known as normal pressure hydrocephalus, which mainly affects older people, typically starts with difficulty walking. Urinary incontinence often develops, along with a type of dementia marked by slowness of thinking and information processing.

The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate. One end of the tubing is usually placed in one of the brain's ventricles.

Sunday, December 26, 2010

Management of Intracranial Tumors and the Basic Pathogenesis of Hydrocephalus

Tumors that invade the base of the skull from below
Nasopharyngeal carcinoma infiltrates the base of the skull to produce paralysis of several cranial nerves arising from the medulla and Pons. Glomus jugulare tumors arise from glomus tissue embedded in the external coat of the jugular vein. These tumors may grow into the jugular foramen leading to pressure effects on the VIII, XII, IX, X and VII cranial nerves. Glomus tumors give to intense pain. Erosion of the jugular foramen can be demonstrated by X-ray.

Secondary deposits
Carcinomas of the lungs and breast are prone to produce cerebral metastases. Other primaries include carcinomas of the Kidneys and alimentary tract. Acute lymphatic leukemia and to a lesser extent acute myeloid leukemia may produce lesions in the central nervous system. Lymphomas also may produce neurological manifestations by infiltration.

management of intracranial tumors
Early diagnosis is very essential. A high index of clinical suspicion is absolutely essential to plan the appropriate investigation. Advent of CT has revolutionized the diagnosis and early detection is possible in the vast majority of cases. Treatment consists of surgical removal wherever possible, radiotherapy or both. Palliative measures include radiotherapy, medical measures to relieve rasied ICT, anticonvulsants, and procedures to relieve obstructive hydrocephalus.

Hydrocephalus (Syn: Hydrencephalus)
Dilatation of the ventricular system of the brain due to accumulation of CSF is called hydrocephalus.This may be congenital or acquired. If the communication between the ventricular system and the subarachnoid space remains patent, it is called communicating hydrocephalus. If this communication is blocked, it is termed obstructive hydrocephalus. In some cases the hydrocephalus may be normotensive, i.e, the pressure in the ventricular systems may be normal, in others it may be raised.

In congenital hydrocephalus and those developing in early infancy, the fontanelles and skull sutures separate and the head is enlarged. The eyeballs are depressed and optic atrophy may develop. The brain and skull are thinned out. Percussion over the skull may give a cracked-pot note.

Causes of hydrocephalus developing in infancy:
1. Bleeding into the brain during delivery and subsequent adhesions.
2. Congenital absence of arachnoid granulations
3. Stenosis of the aqueduct
4. Improper development of the mantle layer of the brain. In the early stages of embryonal development, the ventricular system is relatively larger. As the mantle layer develops and the brain grows this relative disparity disappears. In conditions where the mantle layer does not develop normally, hydrocephalus persists.
5. Arnold-Chiari malformation.
6. Obstruction to the foramina of Magendie and Lushka. In Dandy Walker syndrome, the obstruction is congenital.

Course and prognosis: If the obstruction if not relieved, the condition progresses, Mental deficiency, paralysis, and convulsions may develop in many.

Treatment: Surgical procedures are available to divert CSF from the ventricles and relieve tension using suitable valves. In ventriculo-peritoneal shunt, the CSF is diverted into the Peritoneum; in Ventriculo-atrial shunt the CSF is diverted into the right atrium, Ventriculo-sinus shunt- the sagital sinus; and then the theco-peritoneal shunt- draining the spinal subarachnoid space into the peritoneum.

National Hydrocephalus Awareness Month

Sunday, December 19, 2010

Thursday, December 16, 2010

Monday, December 13, 2010

Sunday, December 12, 2010