 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.

 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.

 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.

 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.

 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)

 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.

 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  Complications leading to progressive neurological dysfunction  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)

 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 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).