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Condition/Disorder Synonym

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  • Raised/increased intracranial pressure

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ICD-9-CM Code

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  • 331.4 Hydrocephalus

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ICD-10-CM Code

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  • G91.9 Hydroycephalus (acquired) (external) (internal) (malignant) (recurrent)

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Preferred Practice Patterns

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Key Features

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Description

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  • Increased intracranial pressure (ICP) beyond what cranium and vertebral column can accommodate

  • Reduced cerebrospinal fluid (CSF) production, decreased cerebral blood volume

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Essentials of Diagnosis

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  • Change in ICP for a given change in intracranial volume is called intracranial compliance

  • Normal compliance curve begins steep rise at approximately 25 mmHg

  • If brain, blood, CSF volumes continue to increase, accommodative mechanisms fail and ICP rises exponentially

  • Diagnosis made via monitoring intracranial pressure

    • Above 25 mmHg considered hydrocephalus

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General Considerations

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  • Numerical difference between ICP and mean blood pressure in cerebral vessels is the cerebral perfusion pressure

    • A widespread reduction in cerebral perfusion occurs as ICP approaches the mean systemic blood pressure, resulting in ischemia and brain death

    • Reduced cerebral perfusion pressure can result in cerebral infarction

  • Normal ICP range between 2 to 5mmHg

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Demographics

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  • Hydrocephalus can occur in any age group

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Clinical Findings

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Signs and Symptoms

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  • Headache

  • Neck pain

  • Nausea

  • Vomiting

  • Drowsiness

  • Ocular palsy

  • Papilledema

  • Confusion

  • Gait disturbance

  • Positive Babinski

  • Increased tone in limbs

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Functional Implications

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  • Decreased cognitive or physical interaction with environment

  • Poor safety with gait and balance activities

  • Decline in judgment or problem solving

  • Decline or loss of independence with ADLs

  • Inability to participate school, work, recreational activities

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Possible Contributing Causes

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  • Cerebral or extracerebral mass (tumor, edema, abscess)

  • Generalized brain swelling

  • Increased venous pressure (venous sinus thrombosis, heart failure)

  • Choroid plexus tumor

  • Meningitis

  • Ventricle obstruction

  • Chiari malformation

  • Arteriovenous malformation

  • Myelomeningocele

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Differential Diagnosis

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  • Chiari malformation

  • Cerebrovascular accident

  • Parkinson's disease

  • Brain tumor

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Means of Confirmation or Diagnosis

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Imaging

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  • CT for detailed imaging of brain

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Diagnostic Procedures

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  • ICP monitoring

  • Lumbar puncture with progressive fluid reduction

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Referrals/Admittance

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  • To ER physician if acute onset

  • To neurologist for monitoring

  • To neurosurgeon for shunt placement if patient is a candidate

  • Other services as needed based on impairments (occupational therapy, speech therapy, neuropsychologist)

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