Ventricular dilatation

CSF flow obstruction or impaired —» absorption

Ventricular dilatation

CSF flow obstruction or impaired —» absorption

CSF permeates through the ependymal ^ lining into the periven-tricular white matter

Raised intracranial pressure White matter damage and gliotic scarring.

Some CSF absorption occurs from periventricular blood vessels.

In the infant, prior to suture fusion, head expansion and massive ventricular dilatation may occur, often leaving only a thin rim of cerebral 'mantle'. Untreated, death may result, but in many cases the hydrocephalus 'arrests'; although the ventricles remain dilated, intracranial pressure (ICP) returns to normal and CSF absorption appears to balance production. When hydrocephalus arrests, normal developmental patterns resume, although pre-existing mental or physical damage may leave a permanent handicap. In these patients, the rapid return of further pressure symptoms following a minor injury or infection suggests that the CSF dynamics remain in an unstable state.

CLINICAL FEATURES Infants and young children

Tense anterior fontanelle

Acute onset -irritability, impaired conscious level and vomiting

Gradual onset -mental retardation, failure to thrive

Thin scalp with dilated veins

Thin scalp with dilated veins

Cracked pot' sound on skull percussion

Increased skull circumference (compare with normal growth curves, corrected for child's height and weight)

- Lid retraction

— Impaired upward gaze - from pressure transmission to the midbrain tectum

'setting sun' appearance

Juvenile/adult type hydrocephalus

Acute onset - signs and symptoms of | ICP — headache, vomiting, papilledema.

- impaired upward gaze deterioration of conscious level

Gradual onset - dementia ) This triad of symptoms may occur despite an

-gait ataxia > apparently 'normal' CSF pressure, i.e. NORMAL PRESSURE - incontinenceJ HYDROCEPHALUS (See page 126)

The condition often relates to previous trauma, meningitis or subarachnoid haemorrhage.

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