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The term hydrocephalus is derived from the
Greek words “hydro” meaning water and
“cephalus” meaning head. As the name
implies, it is a condition in which the
primary characteristic is excessive
accumulation of fluid in the brain. The
excessive accumulation of (CSF)
cerebrospinal fluid results in an abnormal
dilatation of the spaces in the brain called
ventricles. This dilatation causes potentially
harmful pressure on the tissue of the brain.
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Hydrocephalus may be congenital or
acquired.
Congenital hydrocephalus is present at
birth, and may be caused be either
environmental influences during fetal
development or genetic predisposition.
Acquired hydrocephalus develops at the
time of birth or at some point afterwards.
This type can affect individuals of all ages
and may be caused by injury or disease.
Two other forms of hydrocephalus which don’t
fit distinctly into those categories are
hydrocephalus ex-vacuo, and normal pressure
hydrocephalus.
* Ex-vacuo occurs when there is damage to the
brain caused by stroke of a traumatic injury.
* Normal pressure hydrocephalus commonly
occurs in the elderly, due to aging.
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Hydrocephalus is the result when the flow of
CSF is disrupted when your body doesn't
absorb it properly. CSF provides a number of
important functions, including acting as a
cushion for protection and transporting
nutrients to the brain.
There are two main causes; obstructive and
non-obstructive.
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This type of hydrocephalus results from an
obstruction within the ventricular system of
the brain that prevents CSF from flowing or
“communicating” within the brain.
The most common type is a narrowing of a
channel in the brain that connects two
ventricles together.
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This type results from problems with the
production or absorption of CSF.
The most common is caused by bleeding into the
subarachnoid space in the brain.
* Enlargement of the head
* Bulging fontanels
* Sutures are separated
* Vomiting
* Decreased mental function
* Delayed movements
* Difficulty feeding
* Excessive sleepiness
* Brief, shrill, high-pitched cry
* Slow growth (0-5 years)
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Tapping with the fingertips on the skull
may show abnormal sounds associated with
thinning and separation of skull bones.
Scalp veins may appear dilated.
Eyes are depressed.
Tran illumination
Head CT scan
Lumbar punctures (spinal taps)
Skull X-rays
Echoencephalogram
The main goal is to minimize or prevent brain
damage by improving CSF flow.
Surgical interventions are the primary
treatment, including direct removal of the
obstruction, if possible.
A surgical shunt within the brain may allow
CSF to bypass the obstructed area, if
obstruction cannot be removed.
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Hydrocephalus and the Arnold-chiari malformation
are CNS abnormalities that are closely associated with
spina bifida.
Causes
- Overproduction of CSF
- Failure in absorbtion of CSF
- Obstruction in the normal flow of CSF through the
brain structures and spinal cord.
- Obstruction by the arnold-chiari malformation is
considered to be the primary cause of hydrocephalus
in most children with spina bifida.
Arnold Chiari type II Malformation:
 cerebellar hypoplasia
(hypoplasia = reduced growth)
 with caudal displacement of
the hindbrain through the
foramen magnum
 usually associated with
hydrocephalus
 Cranial
Nerve Palsies
 Visual Deficits
 Pressure from the enlarged ventricles affecting adjacent
brain structures
Cognitive and perceptual problems:
 Potential for lower intellect
 Memory deficits
 Distractibility
 “Cocktail party personality” (chattering speech - with
limited content)
 Visual perceptual deficits
Motor dysfunction:
 Upper limb incoordination: halting and deliberate
movement instead of smooth continuous movement
 Spasticity: related to upper motor neuron lesions
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Complications leading to progressive neurological
dysfunction
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Syringobulbia (syringes occurring in the brainstem)
Syringomyelia (syringes anywhere in the spinal cord)
Bowel and/or Bladder Dysfunction: potential for neurogenic
bowel and/or bladder (requires clean, intermittent
catheterization on a regularly timed schedule)
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Hydrocephalus
Hydromyelia
Tethering
of the spinal cord: fixation or tethering
of the distal end of the spinal cord causing intermittent
bowstringing of the spinal cord between the normal
cephalic attachment and the point of tether
Seizures
 Skin
Breakdown
 Decubitus ulcers and other types of skin breakdown
 Obesity
 Latex Allergy
Medical Management
 Surgical closure of back lesion 24-48 hrs after birth
with shunt insertion within 6 months
Pre-closure:
◦ MMT, ROM assessment, therapeutic
positioning for sleeping.
Post-closure:
◦ MMT, sensory assessment, home
program instruction (PROM exercises,
handling and carrying positions, and
therapeutic positioning for sleeping).