Hydrocephalus: Diagnosis and Management

by Kevin Pei, MD

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    00:01 What about a non-communicating hydrocephalus? This can behave like a mass effect.

    00:08 Mass such as a tumor or an extrinsic obstruction of the normal CSF drainage pathway.

    00:14 Recall a few slides back, the choroid plexus, all the way to the subarachnoid space, is a defined pathway.

    00:21 Any obstruction along that pathway can cause a non-communicating hydrocephalus.

    00:26 Remember, the brain has had less time to compensate and more likely to develop intracranial hypertension.

    00:34 Besides our physical and history, imaging diagnosis can be helpful.

    00:39 Generally speaking, we get a CAT scan.

    00:41 The arrow is pointing to you a very decreased amount of lateral ventricle space.

    00:47 In this MRI image, you notice quite dilated ventricles.

    00:52 This probably represents a CSF accumulation due to the lack of absorption rather than an obstruction.

    00:58 Now, you’ve diagnosed hydrocephalus.

    01:02 When do we need to treat it? Well, indications for treatment, which includes a ventricular peritoneal shunt, is when the patient becomes symptomatic.

    01:11 In this shunt procedure, a catheter is placed between the ventricles, tunneled under the skin and introduced into the abdomen.

    01:19 Although a fairly routine procedure, it does contain some complications.

    01:23 Mostly, as you can imagine, if the catheter is in the abdomen, intestines can loop around it.

    01:28 This catheter can be clogged and becomes dysfunctional.

    01:32 It may need to be replaced.

    01:34 Additionally, also remember, sometimes the ventricular peritoneal shunt is actually a ventricular plural shunt.

    01:41 That's when the ventricular drainage catheter is placed into thoracic – into the thoracic space as opposed into the abdomen.

    01:49 Some reasons that neurosurgeons may choose to place it into the thoracic space as opposed to the abdominal space is because of prior surgeries in the abdomen.

    01:58 As we previously described, this catheter sits in the ventricle, is tunneled, as you can see in this schematic, either into the thoracic space or into the abdomen.

    02:08 Now, it’s time to remind you of some clinical pearls and high-yield information on hydrocephalus.

    02:14 Remember the classic findings of normal pressure hydrocephalus? Although rare, it's a popular test question.

    02:21 It requires a high index of suspicion, so you as a clinician should think about normal pressure hydrocephalus.

    02:28 If the clinical scenario presents with classic findings, you have your answer.

    02:34 And remember, Arnold-Chiari syndrome.

    02:37 This syndrome is a skull malformation that can cause cerebellar tonsils to displace inferiorly.

    02:44 This actually causes an obstruction.

    02:46 So, this would not be an example of normal pressure hydrocephalus.

    02:50 This is so-called non-communicating hydrocephalus.

    02:54 This is high-yield information.

    02:56 I’d encourage you to commit it to memory.

    02:59 Thank you very much for joining me on this discussion of hydrocephalus.

    About the Lecture

    The lecture Hydrocephalus: Diagnosis and Management by Kevin Pei, MD is from the course Special Surgery.

    Included Quiz Questions

    1. Arnold-Chiari syndrome
    2. Lou Gehrig's disease
    3. Brain aneurysm
    4. Syringomyelia
    5. Tethered cord syndrome
    1. Ventriculoperitoneal shunt
    2. Ventriculopleural shunt
    3. Ventriculocaval shunt
    4. Ventriculosubgaleal shunt
    5. Ventriculogallbladder shunt

    Author of lecture Hydrocephalus: Diagnosis and Management

     Kevin Pei, MD

    Kevin Pei, MD

    Customer reviews

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    By Marlowe D. on 24. March 2020 for Hydrocephalus: Diagnosis and Management

    great lecture. I am now very clear on the differentials. Thanks

    Doesn't cover enough
    By Medstudent P. on 02. June 2019 for Hydrocephalus: Diagnosis and Management

    Nothing about what to look for on the scan, the exact diagnosis criteria, indicitons for treatment etc.

    To basic
    By Santiago A. on 18. October 2017 for Hydrocephalus: Diagnosis and Management

    Very little information is given, I understand lectures need to be easy and contain important information but this is a summary of a summary