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

Clinical Features

• Headache
• Diplopia
• Ocular Palsy - 6th nerve palsy, strabismus
• Papilledema
• Nausea and Vomiting
• Altered Mental Status
• Peds (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

• Psuedotumor cerebri
• Meningitis
• Temporal arteritis
• Cavernous sinus or cerebral sinus thrombosis
• Migraine, Tension, or Cluster headaches
• Pre-eclampsia
• Hypertensive urgency/emergency
• Carbon monoxide poisoning
• Febrile Headache (ex: pyelonephritis, nonspecific viral infection)

Evaluation

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

See Also

• Normal pressure hydrocephalus
• Ventriculoperitoneal shunt obstruction