HIDROSEFALUS

By:

Aprijal Khairil Bhakti

Winda Permatasari

Introduction

• CSF is produced continuously in the CNS• The total volume of CSF -> 125 ml• Secretion speed choroid plexus -> 500-750 ml / day• CSF Pressure -> 13 mmHg• Function of CSF:

1. protects the central nervous system of trauma (pressure / impact)

2. maintaining appropriate fluid environment for the brain

3. provide protection against mild collision and other mechanical injuries (as bumpers / buffer).

4. makes the brain remain stable in place even though there is collisions of the outsiders.

DEFINITION

• Hydrocephalus is a buildup of cerebrospinal fluid active system that causes dilatation of the ventricles of the brain. (Mitayani, 2011: 197)

CLASSIFICATIONS

1. Based on the blockagea. Obstructive hydrocephalus

Increased intracranial pressure caused by an obstruction in one of the establishment of the CSS, among other things koroidalis plexus and the release of the fourth ventricle through the foramen luscka and magendi.b. Communicant hydrocephalus KS

An increase in intracranial pressure without any blockage in one of the establishment of the CSS.

2. Based on acquisitiona. Congenital hydrocephalus

At birth, the brain is formed of small or disrupted due to brain growth driven by the amount of fluid in the head and high intracranial pressure.b. Hydrocephalus obtained

Brain growth occurs already perfect and then an interruption due to the high intracranial pressure.

ETIOLOGY

0-2 years• congenital abnormalities• intrauterine infection• intrakranial bleeding due

to trauma• bacterial and viral

meningoencephalitis, as well as tumor or arachnoid cyst.

2-10 years• posterior fossa tumors• stenosis akuaduktus

CLINICAL MANIFESTATIONS

Have an enlarged skull Vomiting and headaches The head looks bigger than the body Fontanelle large dilated and did not

close in time, palpable tension and stand

Wide forehead, scalp thin, taut and shiny

Widening scalp veins

CLINICAL MANIFESTATIONS

cracked pot flower pots cracking sound when performed percussion head

sunset sign of eyes eyeball irregular movement Damage to nerves that can give symptoms

of neurological disorders, such as: impaired consciousness; seizures; sometimes vital center disruption.

DIAGNOSTIC EXAMINATION

fronto-occipital head measurement MRI CT Scan

TREATMENT

• Treatment causal• Installation of a drain ->

Shunting• In a state of emergency with

very high intracranial pressure -> puncture ventricle through the anterior fontanelle that still open, to issue a number of liquor to decompress.

ASSESSMENT

• Health historya. Health history of previous diseaseA history of infection of the meninges, premature birth, head trauma.

b. Health history of current diseaseEnlargement of the skull, headache, neurologic complaints such as eye always downward, motor development disorders, visual disturbances, seizures, nausea and vomiting, and loss of consciousness.

c. History of family diseaseMaternal history of intrauterine infection: viral and bacterial.

PHYSICAL EXAMINATION

a. General condition• A decrease in consciousness• Changes TTV (Increased systolic blood pressure, bradicardia,

increased respiratory rate.

b. Head• The existence of enlargement of the skull• Sutures were still open looks fronto-occipital head circumference that

continues to expand• Suture increasingly stretched with convex and tense fontanelle• Veins commonly seen protruding scalp• In the percussion head, sounds like a cracked flower pot (cracked pot

sign).

PHYSICAL EXAMINATION

c. Eye• The eyes always look down• There is edema of the brain nerve II pupil at funduscopic examination• The eyeball is pushed down by the pressure of supra orbital bone thinning• Sclera looks over the iris• Irregular movement of the eyeball.

d. Gastrointestinal System -> Nausea and vomiting due to increased intracranial pressure.

e. ExtremityMotor development disorders.

Psychology and sociala. Maternal anxiety due to the physical changes the baby and also due to lack of knowledge of information.b. The relationship of mother and others will be disrupted because of defects in the baby.

NURSING DIAGNOSE

1. Increased intracranial pressure related to the accumulation of cerebrospinal fluid.

2. Sensory perception disorders related to occipital lobe suppression due to increased ICP.

3. Lack of knowledge related to the disease suffered by his/her son.

4. The risk of ineffective breathing patterns related to decreased cough reflex.

5. Impaired growth and development related to enlargement of the head.

6. High risk of infection related to the installation of drain / shunt.

7. Nutrition less than body requirements related to vomiting secondary to cerebral compression and irritability.