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1、HYDROCEPHALUSW&W495-503HydrocephalusAsyndrome,orsign,resultingfromdisturbancesinthedynamicsofcerebrospinalfluid(CSF),whichmaybecausedbyseveraldiseases.IncidenceOccursin3-4ofevery1000births.Causemaybecongenitaloracquired.Congenital-maybeduetomaldevelopmentorintrauterineinfect
2、ionAcquired-maybeduetoinfection,neoplasmorhemorrhage.PathophysiologyCSFisformedbytwomechanisms:Secretionbythechoroidplexus,Lymphatic-likedrainagebytheextracellularfluidinbrain.CSFcirculatesthruventricularsystemandisabsorbedwithinsubarachnoidspacesbyunknownmechanism.Mechanism
3、sofFluidImbalanceHydrocephalusresultsfrom:1.ImpairedabsorptionofCSFwithinthesubarachnoidspace(communicatinghydrocephalus),or2.ObstructiontotheflowofCSFthroughtheventricularsystem(non-communicatinghydrocephalus)MechanismsoffluidimbalanceBothleadtoincreaseaccumulationofCSFinth
4、eventricles!Ventriclesbecomedilatedandcompressthebrain.Whenthishappensbeforecranialsuturesareclosed,skullenlarges.Inchildren<10-12,previouslyclosedsuturesmayopen.HydrocephalusMostcasesofnon-communicating(obstructive)hydrocephalusarearesultofdevelopmentalmalformations.Otherca
5、uses:neoplasms,intrauterineinfections,trauma.Developmentaldefectsaccountformostcausesofhydrocephalusfrombirthto2yearsofage.(Table11-3,page497-sitesandtypesofhydrocephalus)CommonDefectsArnold-ChiariMalformation(ACM)Type2malformationofbrainseenmostexclusivelywithmyelomeningoce
6、le,ischaracterizedbyherniationofasmallcerebellum,medulla,pons,andfourthventricleintothecervicalspinalcanalthroughanenlargedforamenmagnum.ClinicalmanifestationsClinicalpicturedependsonacuityofonsetandpresenceofpreexistingstructurallesions.InfancyHeadgrowsatalarmingratewithhyd
7、rocephalus.Firstsigns-bulgingoffontanelswithoutheadenlargement.Tense,bulging,non-pulsatileanteriorfontanelDilatedscalpveins,esp.whencryingThinskullboneswithseparatedsutures(crackedpotsoundsonpercussion)InfancyProtrudingforeheadorbossing.Depressedeyesorsetting-suneyes(eyesrot
8、atingordownwardwithscleravisibleabovepupil)Pupilssluggishwithunequalrespons
