Hydrocephalus involves enlargement of all or part of the ventricular
system due to production of CSF at a rate greater than the rate of removal.
Usually this condition is associated with an increase in intraventricular
pressure, but, rarely, "low pressure hydrocephalus" occurs in
elderly patients who exhibit neurological signs. Hydrocephalus is associated
with many inherited syndromes.
Clinically, the presence of hydrocephalus in the infant can be ascertained
by analyzing head and fontanelle size and by evaluating skull x-rays and
CAT scans. Treatment basically consists of shunting the cerebrospinal fluid
directly from some point in the ventricular system, usually the lateral
ventricle, to some other point beyond the obstruction (usually the jugular
vein, right atrium or peritoneum). In children, prompt treatment of hydrocephalus
uncomplicated by severe spina bifida allows about half of the children to
compete successfully with their peers. Followup at six month intervals is
mandatory. Infection is the most common and serious complication which mitigates
against a higher percentage of successfully treated patients.
There are two major classes of hydrocephalus: noncommunicating and
communicating. In non-communicating hydrocephalus, fluid in the
lateral ventricle does not 'communicate' with the lumbar subarachnoid space
because there is an occlusion at the foramen of Monro, aqueduct of Sylvius,
or foramina of Luschka and Magendie. In communicating hydrocephalus,
on the other hand, fluid from the lateral ventricles can be recovered from
the lumbar subarachnoid space because there is no occlusion . Commonly,
an obstruction occurs in the subarachnoid space.
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