Hydrocephalus

Hey everybody, in this lesson we are going to be talking about the diagnosis hydrocephalus.

The name hydrocephalus actually just tells you straightaway what the diagnosis means. You have hydro which means water and cephalus which refers to the head. So, there’s an excess amount of fluid, Cerebral Spinal Fluid to be exact, in the brain.

There are two different types of hydrocephalus the first is the communicating hydrocephalus and this just means that there is no obstruction to the flow of CSF in the brain. So the excess is being caused by overproduction or poor absorption. Problems that may cause this are infections like meningitis, or a hemorrhage. Non-communicating hydrocephalus is caused by something blocking the flow of CSF. Diagnoses that may cause this are tumors and congenital anomalies like Chiari malformations. These account for most cases of hydrocephalus in babies. Where in older kids the cause is likely to be infection or trauma.

Your assessment of a child with hydrocephalus is really all about looking for signs of increased intracranial. pressure.

The head may be visibly enlarged or it may just be slightly enlarged and you’ve noticed this from daily head circumference measurements. Remember, head circumference is measured and monitored until children are 2-3 years of age to keep an eye out for even small variations that could indicate hydrocephalus.

Another classic symptoms associated with hydrocephalus something called sunsetting eyes. The pressure in the brain is actually pushing the eyes down, causing there to be a lot of white or sclera at the visible at the top. We’ve included a picture of this in the resources so take a look at it so you know exactly what you are looking for.

Other classic symptoms of increased and cranial pressure in older children are nausea and vomiting, headache, changes in gate or poor coordination, decreased level of consciousness, and vision changes (so things like for a photophobia, strabismus and blurred vision). In babies and young kids, you are very unlikely to see these classic symptoms, mostly because they can’t tell you about them. So symptoms that may indicate increased ICP for them are poor feeding, a shrill or high-pitched cry and bulging fontanels.

Most children who have hydrocephalus are going to need to have surgery. About 75% are going to have a shunt placed to help drain the CSF out of the brain where it is causing problems.

There are two different types of shunts. The first is a ventriculoperitoneal shunt and the second is a endoscopic third ventriculostomy. The VP shunt is going to drain cerebrospinal fluid from the ventricle, through a tube that goes down into the abdomen. You can see in the photo here with that looks like. The ETV creates an opening in the third ventricle that allows the fluid to drain out

For post-op care, one of the most important things is to make sure that you have an order from the provider that gives very specific guidelines on how to position the patient and how much activity they are allowed to have. Often, the orders are to have the child lay on the unoperated side to prevent occlusion of the shunt. And activity is limited and the child is kept flat for a while to prevent rapid draining of CSF.

The two biggest complications after placement of a shunt are infection and obstruction. So, it’s really important to be on the lookout for signs of infection and then also signs of increased intracranial pressure which indicate that the shunt isn’t working.

Your priority nursing concepts for pediatric patient with hydrocephalus are intracranial regulation, cognition and infection control.

Let’s go over your key points for this lesson! Hydrocephalus is when there is an excessive amount of CSF in the brain. This can either be from excessive formation, decreased absorption or obstructed flow. Possible causes of this are things like meningitis, trauma and hemorrhage, tumors and congenital anomalies. The primary things to be on the lookout for are signs of increased intracranial pressure, head circumference and sunsetting eyes are key findings. Keep in mind that babies can’t report a lot of the classic symptoms so they may present with poor feeding, high pitched cry and bulging fontanels.

In most cases patients are going to need to have a shunt placed, either the VP shunt or the ETV shunt. Post-op care is all about monitoring position and activity and looking for signs of infection and increased intracranial pressure that could indicate the shunt isn’t working.

That's it for our lesson on hydrocephalus. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!