RT Book, Section
A1 Fuchs, Susan
A2 Schafermeyer, Robert
A2 Tenenbein, Milton
A2 Macias, Charles G.
A2 Sharieff, Ghazala Q.
A2 Yamamoto, Loren G.
SR Print(0)
ID 1105683085
T1 Hydrocephalus
T2 Strange and Schafermeyer's Pediatric Emergency Medicine, 4e
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-182926-7
LK accesspediatrics.mhmedical.com/content.aspx?aid=1105683085
RD 2024/04/20
AB Hydrocephalus  refers  to  the  excess  accumulation  of  cerebrospinal  fluid  (CSF).  Most  cases  result  from  congenital  or  acquired  obstructions  to  the  flow  of  CSF  from  the  brain  to  the  spinal  canal.Infants  with  hydrocephalus  are  often  diagnosed  on  routine  examination  by  finding  head  circumference  disproportionately  large  for  age  or  splitting  of  the  cranial  sutures.Older  children  with  hydrocephalus  will  usually  complain  of  headache,  which  is  often  progressive  in  nature,  worse  in  the  morning,  awakens  the  patient  from  sleep,  and  is  exacerbated  by  lying  down  or  straining.It  is  imperative  to  begin  treatment  in  the  unstable  patient  before  herniation  occurs.  Patients  who  are  lethargic  on  presentation,  those  with  a  Glasgow  Coma  Scale  <8,  or  those  who  deteriorate  in  the  emergency  department  are  intubated  following  rapid  sequence  induction  procedures  and  ventilated  to  maintain  Pco2  at  35  torr.  If  there  are  signs  of  herniation  such  as  unequal  pupils,  fixed  and  dilated  pupils,  or  posturing,  mild  hyperventilation  can  be  helpful  on  a  short-term  basis.Patients  who  do  not  respond  with  an  improved  mental  status  after  intubation  and  controlled  ventilation  may  benefit  from  diuretic  therapy  with  mannitol  or  furosemide.After  the  patient  is  stabilized,  a  computed  tomography  scan  or  magnetic  resonance  image  of  the  brain  is  performed  to  define  the  lesion  and  plan  definitive  treatment.