Hydrocephalus

• Raised/increased intracranial pressure

• 331.4 Hydrocephalus

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

• 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System – congenital origin or acquired in infancy or childhood1
• 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System – acquired in adolescence or adulthood2
• 5E: Impaired Motor Function and Sensory Integrity Associated with Progressive Disorders of the Central Nervous System3

Description

• Increased intracranial pressure (ICP) beyond what cranium and vertebral column can accommodate
• Reduced cerebrospinal fluid (CSF) production, decreased cerebral blood volume

Essentials of Diagnosis

• 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

General Considerations

• 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

Demographics

• Hydrocephalus can occur in any age group

Signs and Symptoms

• Headache
• Neck pain
• Nausea
• Vomiting
• Drowsiness
• Ocular palsy
• Papilledema
• Confusion
• Gait disturbance
• Positive Babinski
• Increased tone in limbs

Functional Implications

• 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

Possible Contributing Causes

• 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

Differential Diagnosis

• Chiari malformation
• Cerebrovascular accident
• Parkinson’s disease
• Brain tumor

Imaging

• CT for detailed imaging of brain

Diagnostic Procedures

• ICP monitoring
• Lumbar puncture with progressive fluid reduction

• 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)

• Attention
• Cognition
• Motor planning
• Cranial nerve integrity
• Gait
• Sitting and standing balance (static and dynamic)
• Muscle strength, coordination
• Postural control
• Muscle tone
• Sensation
• Bed mobility
• Transfers
• Endurance
• Self-care
• Home management
• Fine-motor control

• Glasgow Coma Scale
...