Hydrocephalus: Etiology and Examination

by Kevin Pei, MD

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    00:01 Thanks for joining me on this discussion of hydrocephalus in the section of neurosurgery.

    00:07 Let’s start by asking you a question.

    00:09 What are the causes of hydrocephalus? I’ll give you a second to think about this.

    00:16 Hydrocephalus is caused by anything that increases the volume of the CSF.

    00:21 You may recall from our discussion in the trauma series about the Monro-Kellie doctrine.

    00:26 Remember, the skull is a fixed space containing CSF, brain and blood.

    00:33 This is a little different than traumatic brain injury patients because CSF and hydrocephalus develops over time.

    00:40 And as a result, there's some compensatory mechanisms in play, so that the patient does not herniate, like a traumatic brain patient.

    00:49 Now, let's review the normal drainage of the CSF.

    00:52 As you know, CSF is produced in the choroid plexus.

    00:56 It then travels to the lateral ventricle, third ventricles, fourth ventricles and eventually dumps into the subarachnoid space.

    01:06 Any obstruction along this pathway can cause CSF hydrocephalus.

    01:14 What are some physical findings of hydrocephalus? Commonly, cognitive deterioration.

    01:20 This may be subtle.

    01:21 It may not be a comatose patient, somebody who's got increasing confusion.

    01:26 It may, particularly in elderly patient, present as suspicion for dementia.

    01:33 Maybe the patient has some vomiting.

    01:36 And frequently patients discuss nuchal rigidity and neck pain.

    01:40 Sometimes, patients are suspected of having meningitis in these situations.

    01:47 Frequently, patients also present with imbalance and gait disturbances.

    01:55 Let's discuss normal pressure hydrocephalus.

    01:59 Normal pressure hydrocephalus is very high yield and it's got a classic association syndrome.

    02:05 That includes gait disturbances, dementia, urinary incontinence.

    02:12 In general, normal pressure hydrocephalus – in other words, it doesn't increase intracranial pressures – are communicating in nature.

    02:20 It's usually due to a decreased absorption as opposed to an obstructing hydrocephalus.

    02:26 And as we discussed previously, they tend to be chronic and slow.

    About the Lecture

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

    Included Quiz Questions

    1. Choroid plexus, lateral ventricle, 3rd ventricle, 4th ventricle
    2. Choroid plexus, 3rd ventricle, lateral ventricle, 4th ventricle
    3. Choroid plexus, lateral ventricle, 4th ventricle, 3rd ventricle
    4. Choroid plexus, lateral ventricle, 4th ventricle, sub-arachnoid space
    5. Choroid plexus, 4th ventricle, 3rd ventricle, lateral ventricle
    1. Urinary incontinence
    2. Excessive sleepiness
    3. Seizures
    4. Contralateral loss of pain and temperature sensations
    5. Saddle numbness

    Author of lecture Hydrocephalus: Etiology and Examination

     Kevin Pei, MD

    Kevin Pei, MD

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