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Pediatric Hydrocephalus Treatment and Diagnosis

The document discusses hydrocephalus as an abnormal accumulation of cerebrospinal fluid (CSF) in the brain's ventricles, detailing its causes, clinical manifestations, and treatment options. Diagnosis can involve imaging studies, while treatment typically includes ventricular shunting or endoscopic procedures. Physiotherapy interventions aim to enhance physical and cognitive development, mobility, and overall quality of life for affected individuals.

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HYDROCEPHALUS By Dr. Rima Jani MPT (PED) 1
Embryology • Closure of neural tube by 28 days of gestation. • Certain portions of central lumen expand to form basic pattern of ventricular sytem. forebrain midbrain hindbrain lateral 3rd cerebral aqueduct 4th 2 Hydrocephalus
The fluid-filled cavities in the developing neural tube of the embryo form the ventricles of the mature brain. 3 Hydrocephalus
Ventricles  Ventricles are filled with cerebrospinal fluid (CSF) produced by the choroid plexus. ant body in po 4 Hydrocephalus
CEREBROSPINAL FLUID (CSF) A specialized extracellular fluid produced by choroid plexi which bathes, supports and protects the brain and spinal cord. 5 Hydrocephalus
CEREBROSPINAL FLUID (CSF)  CSF is produced by choroid plexi of lateral, 3rd and 4th ventricles.  Normal total volume of CSF is about 130-150 ml.  30-50 ml in the ventricles, 100 ml in the subarachnoid space.  CSF is produced/resorbed by the choroid plexus/arachnoid granulations at a rate of about 20 ml / hr or 500 ml / day. 6 Hydrocephalus
CSF CSF Lateral ventricle 3rd ventricle 4th ventricle Subarachnoid space Foramen of Monro Aqueduct of Sylvii Foramen of Luschka and Magendi 7 Hydrocephalus
Hydrocephalus 8  Hydrocephalus is the abnormal accumulation of cerebrospinal fluid (CSF) within cavities called ventricles inside the brain.  CSF is produced in the ventricles, circulates through the ventricular system and is absorbed into the bloodstream HYDROCEPHALUS
HYDROCEPHALUS Increase in ventricular size due to an imbalance between the production of CSF and its drainage by the arachnoid villi. 9 Hydrocephalus
CAUSES OF HYDROCEPHALUS 1) Hydrocephalus can be present at birth (congenital) or 2) Acquired as a result of :  Haemorrhage,  Meningitis,  Head trauma,  Tumours or cysts. Hydrocephalus 10
CLINICAL MANIFESTATIONS  Headache, nausea/vomiting,  Cognitive impairment, decreased level of consciousness,  Papilledema, decreased vision and abducens palsies,  Gait abnormalities. 11 Hydrocephalus
CLINICAL MANIFESTATIONS  Hakim's triad of gait instability, urinary incontinence and dementia is a relatively typical manifestation of the distinct entity normal pressure hydrocephalus (NPH).  Dilated scalp veins,  Anterior fontanel wide open and bulging, increased head circumference,  Setting sun sign,  Brisk tendon reflexes, spasticity  Clonus, Babinsky sign (+) 12 Hydrocephalus
CLINICAL MANIFESTATIONS Hydrocephalus 13 Eyes that appear to gaze downward; Irritability; Seizures; Separated sutures; Sleepiness; Vomiting. Setting Sun Sign
CLINICAL MANIFESTATIONS  Poor Head Control  Learning Disabilities  Poor Psycho-Motor Coordination  Difficulties in Fine-Motor Skills  Spatial orientation—the ability to assess size, distance, direction,  Position or Quantity—may also be impaired.  Problems with Organizational Skills. Hydrocephalus 14
IMAGING STUDIES  X-RAY PLAIN FILMS:  SEPARATION OF SUTURES  ULTRASOUND  MRI 15 Hydrocephalus
Hydrocephalus 16 CT scan of Hydrocephalic child
Hydrocephalus 17
CLASSIFICATION Three major mechanisms account for the development of hydrocephalus:  Overproduction of CSF (communicating type),  Decreased absorption of CSF by arachnoid villi (extraventricular, communicating)  Obstruction to CSF flow (intraventricular, non-communicating), 18 Hydrocephalus
TREATMENT OF HYDROCEPHALUS Persistent compression of the brain Gliosis, cortical distortion, neuronal damage, axonal tearing along longitudinal fibers (internal capsule), and myelin destruction Treatment is mandatory 19 Hydrocephalus
TREATMENT OF HYDROCEPHALUS •Ventricular shunting (VP-VA shunt): CSF diversion • Endoscopic third ventriculostomy (E3V); endoscopic aqueductoplasty (EA) 20 Hydrocephalus
TREATMENT OF HYDROCEPHALUS • Ventricular shunting (VP-VA shunt) CEREBRAL SHUNTS: It involves the placement of a ventricular catheter into the cerebral ventricles to bypass the flow and drain the excess fluid into other body cavities, from where it can be resorbed. 21 Hydrocephalus
Endoscopic Third Ventriculostomy (ETV).  The surgery involves making a tiny hole in the third ventricle of the brain to allow the flow of spinal fluid into another area of the brain for absorption, thus eliminating the need for a shunt. Hydrocephalus 22
TREATMENT OF HYDROCEPHALUS • Complications: •Shunt malfunction, failure and infection, •infection of the shunt tract following surgery (the most common reason for shunt failure is infection of the shunt tract). •Although a shunt generally works well, it may stop working if it disconnects, becomes blocked (clogged), infected, or it is outgrown. •Another complication can occur when CSF drains more rapidly than it is produced. 23 Hydrocephalus
AIMS OF PHYSIOTHERAPY INTERVENTION  Promoting achievement of physical milestones such as sitting, standing, crawling  Maximising independence in mobility  Exercises to improve balance and coordination  Exercises to stretch or strengthen tight or weak muscles  Treating learning disabilities  Improving cognition  Improving confidence and quality of life  Improving tolerance and stamina Hydrocephalus 24
PHYSIOTHERAPY INTERVENTION Post operative:  PHASE I (In I.C.U.)  Prevention of complications  Protection of incision site  Chest clearance  Passive movements of limbs Hydrocephalus 25 Note : Head down position is contraindicated.
PHASE II (In Ward)  Prevention of respiratory & circulatory complications  Ankle toe exercises, active assisted &/or passive movements  Breathing & Chest expansion techniques  Chest clearance techniques  Ambulatory training as soon as patient is stable & fit to move Hydrocephalus 26 PHYSIOTHERAPY INTERVENTION
PHASE III (At O.P.D.) Motor:  Neurodevelopmental techniques  Achieving head control  Reducing spasticity of muscles  Strengthening of weak muscles  Galileo (a technique which uses a vibrating plate to help nerves and muscles work)  Postural training  Gait training (Treadmill therapy), Obstacle walking. Hydrocephalus 27 PHYSIOTHERAPY INTERVENTION
Sensory:  SENSORY DIET Use of different textures, modulation in mat, etc.  VISION Visual scanning, focusing, tracking.  AUDITORY Xylophone activity, listening diff sounds & differentiating.  BALANCE Balancing on unstable surfaces, Reach outs. Hydrocephalus 28 PHYSIOTHERAPY INTERVENTION
Special Education :  To overcome learning disabilities  Play therapy  Fine motor skill training  Use of different instruments to improve ADLs  Puzzle solving  Identification of Shapes, size, colours, animals, fruits, body parts, etc. Hydrocephalus 29 PHYSIOTHERAPY INTERVENTION
PHYSIOTHERAPY INTERVENTION  OCCUPATIONAL THERAPY: To make patient independent – Socially & Financially. Hydrocephalus 30
31 THANK YOU FOR YOUR KINDEST ATTENTION…