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Hydrocephalus encountered in an elderly patient with dementia and incontinence
8%
6/72
Hydrocephalus encountered in a patient with arachnoid scarring after having meningitis
61%
44/72
Hydrocephalus encountered in aqueductal stenosis
19%
14/72
Hydrocephlaus encountered in advanced HIV
4%
3/72
Hydrocephalus encountered in Pick's disease
3%
2/72
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Patients who present with hydrocephalus after meningitis have communicating hydrocephlaus due to decreased CSF absorption by the arachnoid villi leading to elevated intracranial pressure, papilledema, and herniation. The pathophysiology is the same in infants who present with hydrocephalus after subarachnoid hemorrhage where the arachnoid villi and cisterns become destroyed and there is decreased reabsorption of CSF, also leading to a communicating hydrocephalus. Recall the four types of hydrocephalus: normal pressure, communicating, obstructive, and ex vacuo. In normal pressure hydrocephalus, expansion of the ventricles distorts the fibers of the corona radiata leading to the clinical triad of dementia, ataxia, and urinary incontinence. Subarachnoid hemorrhage is the most common cause of communicating hydrocephalus. Obstructive hydrocephalus can be caused by any lesion blocking the CSF circulation. Finally, hydrocephalus ex vacuo actually has an absence of intracranial pressure, but ventricles appear dilated due to brain parenchymal atrophy. LaHood and Bryant discuss outpatient care of the premature infant. 13% of all births in the U.S. are premature. To account for prematurity, growth and development monitoring should be done according to adjusted age in months from term due date. Verrees and Selman discuss management of normal pressure hydrocephalus, an extremely common form of hydrocephalus. The pressure exerted on the cerebral parenchyma by immense fluid-filled cavities deforms white matter tracts. Normal pressure hydrocephalus is often treatable with ventriculoperitoneal shunting. Cohen-Gadol and Bohnstedt discuss recognition and evaluation of nontraumatic subarachnoid hemorrhage and ruptured cerebral hemorrhage. Rates of misdiagnosis and treatment delays for subarachnoid hemorrhage have improved over the years, but these are still common occurrences. Subarachnoid hemorrhage can be more easily diagnosed in patients who present with severe symptoms, unconsciousness, or with thunderclap headache, which is often accompanied by vomiting. First step in diagnosis is a non-contract CT. Figure A represents the classic findings of subarrachnoid hemorrhage on non-contrast CT. Incorrect Answers: Answer 1: Elderly patients who present with the clinical triad of dementia, ataxia, and urinary incontinence have normal pressure hydrocephalus. Answer 3: Stenosis of the aqueduct of Sylvius would result in obstructive (noncommunicating hydrocephalus). Answers 4 and 5: Alzheimer's disease, advanced HIV, and Pick's disease result in hydrocephlaus ex vacuo where intracranial pressure is normal.
5.0
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