rounded 4th ventricle with no recognized cisterna magna is sign of noncommunicating dilatation; triangular 4th ventricle with wide cisterna magna indicates communicating dilatation. subependymal and intraventricular hemorrhage in high-risk premature infants. Coronal sonogram of noncommunicating hydrocephalus Frontal horns (1), temporal horns (2), 3rd ventricle (3) and 4th ventricle (4) are distended: Plain skull films: separation of sutures in older child erosion of posterior clinoids ("beaten-silver appearance" - irregular, shallow increase in convolutional markings scalloping of bone table) with longstanding ICP↑. see p. S50 Radionuclide cisternogram - delayed clearance of radiotracer over cerebral convexities after 48-72 hours challenge see NPH. – Lumbar puncture perform only after imaging rules out obstructive hydrocephalus. measures in noncommunicating hydrocephalus (normal lumbar CSF intracranial pressure; pressure) monitor intraventricular pressure (overnight recording may reveal intermittent → waves of elevated pressure). - fourth ventricle no longer communicates with third ventricle, as well as basal cisterns. various etiologies that cause obstructive hydrocephalus. may have typical symptoms and signs of hydrocephalus or more atypical symptoms such as lower cranial nerve dysfunction; occasionally, incidental asymptomatic finding on imaging. Treat before permanent neurologic deficits develop! Cases that should not be treated: (e.g. child with hydranencephaly). surgery would not affect outcome ventriculomegaly of senescence. (i.e. brain atrophy) hydrocephalus ex arrested hydrocephalus. N.B. children can present with very subtle neurological deterioration (e.g. slipping school performance). It is important to ascertain before operating that hydrocephalus is progressive! occurs in asymptomatic child 6-18 benign communicating hydrocephalus of infancy – months of age; during rapid head growth, ventricles and subarachnoid spaces become quite prominent; pediatrician notes rapid increase in head circumference in otherwise healthy child;
rounded 4th ventricle with no recognized cisterna magna is sign of noncommunicating dilatation; triangular 4th ventricle with wide cisterna magna indicates communicating dilatation. subependymal and intraventricular hemorrhage in high-risk premature infants. Coronal sonogram of noncommunicating hydrocephalus Frontal horns (1), temporal horns (2), 3rd ventricle (3) and 4th ventricle (4) are distended: Plain skull films: separation of sutures erosion of posterior clinoids in older child increase in convolutional markings ("beaten-silver appearance" - irregular, shallow scalloping of bone table) with longstanding ICP↑. see p. S50 Radionuclide cisternogram - delayed clearance of radiotracer over cerebral convexities after 48-72 hours challenge – see NPH. Lumbar puncture perform only after imaging rules out obstructive hydrocephalus. measures intracranial pressure; in noncommunicating hydrocephalus (normal lumbar CSF pressure) → monitor intraventricular pressure (overnight recording may reveal intermittent waves of elevated pressure). - fourth ventricle no longer communicates with third ventricle, as well as basal cisterns. various etiologies that cause obstructive hydrocephalus. may have typical symptoms and signs of hydrocephalus or more atypical symptoms such as lower cranial nerve dysfunction; occasionally, incidental asymptomatic finding on imaging. Treat before permanent neurologic deficits develop! Cases that should not be treated: surgery would not affect outcome (e.g. child with hydranencephaly). ventriculomegaly of senescence. hydrocephalus ex (i.e. brain atrophy) arrested hydrocephalus. N.B. children can present with very subtle neurological deterioration (e.g. slipping school performance). It is important to ascertain before operating that hydrocephalus is progressive! benign communicating hydrocephalus of infancy – occurs in asymptomatic child 6-18 months of age; during rapid head growth, ventricles and subarachnoid spaces become quite prominent; pediatrician notes rapid increase in head circumference in otherwise healthy child;
S60.%20GENERAL%20-%20Hydrocephalus.docx