Hydrocephalus

Background

Hydrocephalus is caused by excessive cerebrospinal fluid (CSF) 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