Hydrocephalus
Background
- Caused by excessive cerebrospinal fluid accumulation, often from an obstructive process such as CSF shunt malfunction or subarachnoid hemorrhage
- Patients can also suffer from nonobstructive hydrocephalus due to excessive production of CSF[1]
Clinical Features
Pediatric hydrocephalus with "sunset eyes."
- Headache
- Diplopia
- Ocular Palsy - 6th nerve palsy, strabismus
- Papilledema
- Nausea and Vomiting
- Altered Mental Status
Pediatric
In addition to above:
- Large fontanelles
- Dilated scalp veins
- "Cracked pot" sound on percussion
- Irritability
- Increased lower extremity tone
- Remember that Babinski sign is normal up to 3 years of age
Differential Diagnosis
Killers
- Meningitis/encephalitis
- Myocardial ischemia
- Retropharyngeal abscess
- Intracranial Hemorrhage (ICH)
- SAH / sentinel bleed
- Acute obstructive hydrocephalus
- Space occupying lesions
- CVA
- Carbon monoxide poisoning
- Basilar artery dissection
- Preeclampsia
- Cerebral venous thrombosis
- Hypertensive emergency
- Depression
Maimers
- Giant cell arteritis of temporal artery (temporal arteritis)
- Idiopathic intracranial hypertension (Pseudotumor Cerebri)
- Acute Glaucoma
- Acute sinusitis
- Cavernous sinus thrombosis or cerebral sinus thrombosis
- Carotid artery dissection
Others
- Trigeminal neuralgia
- TMJ pain
- Post-lumbar puncture headache
- Dehydration
- Analgesia abuse
- Various ocular and dental problems
- Herpes zoster ophthalmicus
- Herpes zoster oticus
- Cryptococcosis
- Febrile headache (e.g. pyelonephritis, nonspecific viral infection)
- Ophthalmoplegic migraine
- Superior Vena Cava Syndrome
Aseptic Meningitis
- Viral
- Tuberculosis
- Lyme disease
- Syphilis
- Leptospirosis
- Fungal (AIDS, transplant, chemotherapy, chronic steroid use)
- Noninfectious
Evaluation
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Typical hydrocephalus as seen on a brain CT. The lateral ventricles (black areas in the middle of the brain) are abnormally large and filled with fluid.
Obstructive hydrocephalus cause by a posterior fossa cyst in a 12 month old. Patient presented with loss of developmental milestones.
- Physical Exam to assess for papilledema or neuro defects
- CT Brain non contrast
- In acute cases will see dilated ventricles and tight sulci
- In chronic cases (loss of tissue with age, alcoholism, etc) will see dilated ventricles with large amount of CSF in sulci
References
- Shprecher D. et al. Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 2008;8(5):371-376.
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