PE27.4 | Hydrocephalus — Summary & Reflection

KEY TAKEAWAYS

Hydrocephalus — Key Points

• Definition: Abnormal accumulation of CSF in the ventricular system → raised ICP
• Classification:
• Communicating: All CSF pathways open; impaired resorption at arachnoid granulations (post-meningitis, post-IVH)
• Obstructive (non-communicating): Blockage within ventricular system (aqueductal stenosis = commonest cause; Dandy-Walker; posterior fossa tumour)
• Hydrocephalus ex vacuo: Ventricular enlargement from brain atrophy — NO raised ICP; NO shunting
• Clinical features (infants): Macrocephaly (↑OFC crossing centiles), tense bulging fontanelle, distended scalp veins, sunset sign
• Clinical features (older children): Morning headache, vomiting, papilloedema, CN VI palsy, Cushing's triad (late)
• Investigations: OFC on centile chart; cranial USG (neonates/infants); CT brain (ventriculomegaly + site of obstruction); MRI for surgical planning
• Management:
• Medical (temporary): acetazolamide, serial LPs
• VP shunt: CSF diverted to peritoneum; complications = blockage, infection (S. epidermidis/S. aureus, first 6 months), over-drainage
• ETV: endoscopic opening in third ventricle floor; preferred in obstructive hydrocephalus in children >6 months

REFLECT

Reflect on the following: You are at a district hospital maternal and child health clinic. A mother brings her 3-month-old for a routine vaccination. You notice the head looks large. She says it has grown fast. You do not have a CT scan at this facility, and there is no neurosurgeon in your district. What is your next step? How do you communicate the significance of your finding to the family without causing panic while ensuring they act urgently? What resources (cranial USG, referral network) would make this scenario easier to manage in a resource-limited Indian setting?