Hydrocephalus classification: Difference between revisions
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Hydrocephalus is classified based upon the underlying cause such as impaired [[cerebrospinal fluid]] ([[CSF]]) flow, impaired [[CSF]] reabsorption, or excessive [[CSF]] production. | Hydrocephalus is classified based upon the underlying cause such as impaired [[cerebrospinal fluid]] ([[CSF]]) flow, impaired [[CSF]] reabsorption, or excessive [[CSF]] production. | ||
==Classification == | ==Classification == | ||
*Based on its underlying mechanisms, hydrocephalus can be classified into: | *Based on its underlying mechanisms, hydrocephalus can be classified into:<ref name="pmid21928019">{{cite journal |vauthors=Rekate HL |title=A consensus on the classification of hydrocephalus: its utility in the assessment of abnormalities of cerebrospinal fluid dynamics |journal=Childs Nerv Syst |volume=27 |issue=10 |pages=1535–41 |date=October 2011 |pmid=21928019 |pmc=3175041 |doi=10.1007/s00381-011-1558-y |url=}}</ref><ref>{{cite journal|doi=10.1186/1743-8454-5-2.}}</ref> | ||
**Communicating (non-obstructive). | **Communicating (non-obstructive). | ||
**Non-communicating (obstructive). | **Non-communicating (obstructive). | ||
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**Acquired. | **Acquired. | ||
=== 1. Communicating hydrocephalus === | ==== === 1. Communicating hydrocephalus === ==== | ||
* | *The mechanism of hydrocephalus is given below:<ref name="pmid21928019">{{cite journal |vauthors=Rekate HL |title=A consensus on the classification of hydrocephalus: its utility in the assessment of abnormalities of cerebrospinal fluid dynamics |journal=Childs Nerv Syst |volume=27 |issue=10 |pages=1535–41 |date=October 2011 |pmid=21928019 |pmc=3175041 |doi=10.1007/s00381-011-1558-y |url=}}</ref><ref>{{cite journal|doi=10.1186/1743-8454-5-2.}}</ref> | ||
*It is caused by impaired [[cerebrospinal fluid]] resorption in the absence of any [[CSF]]-flow obstruction. | **It is caused by impaired [[cerebrospinal fluid]] resorption in the absence of any [[CSF]]-flow obstruction. | ||
*It has been theorized that this is due to functional impairment of the [[arachnoid granulations]]. | **It has been theorized that this is due to functional impairment of the [[arachnoid granulations]]. | ||
*[[Arachnoid granulations]] are located along the [[superior sagittal sinus]] and is the site of [[cerebrospinal fluid]] resorption back into the [[venous]] system. | **[[Arachnoid granulations]] are located along the [[superior sagittal sinus]] and is the site of [[cerebrospinal fluid]] resorption back into the [[venous]] system. | ||
*Various [[Neurological|neurologic]] conditions may result in communicating hydrocephalus, including: | **Various [[Neurological|neurologic]] conditions may result in communicating hydrocephalus, including: | ||
**[[Subarachnoid space|Subarachnoid]]/[[intraventricular hemorrhage]]. | **[[Subarachnoid space|Subarachnoid]]/[[intraventricular hemorrhage]]. | ||
**[[Meningitis]]. | **[[Meningitis]]. | ||
| Line 27: | Line 27: | ||
'''(a) [[Normal pressure hydrocephalus]]''' (NPH): | '''(a) [[Normal pressure hydrocephalus]]''' (NPH): | ||
* NPH is a particular form of communicating hydrocephalus, characterized by enlarged [[Cerebral ventricle|cerebral ventricles]], with only intermittently elevated [[Cerebrospinal fluid|cerebrospinal fluid pressure]]. | * NPH is a particular form of communicating hydrocephalus, characterized by enlarged [[Cerebral ventricle|cerebral ventricles]], with only intermittently elevated [[Cerebrospinal fluid|cerebrospinal fluid pressure]]. | ||
* The [[diagnosis]] of NPH can be established only with the help of continuous [[intraventricular]] pressure recordings (over 24 hours | * The [[diagnosis]] of NPH can be established only with the help of continuous [[intraventricular]] pressure recordings (over 24 hours). | ||
==== (b) Hydrocephalus ex vacuo: ==== | |||
* It refers to an enlargement of [[cerebral ventricle]] | * It refers to an enlargement of [[cerebral ventricle]] | ||
* Hydrocephalus ex vacuo occurs as a result of compensatory enlargement of the [[CSF]]-spaces in response to brain [[parenchyma]] loss. | * Hydrocephalus ex vacuo occurs as a result of compensatory enlargement of the [[CSF]]-spaces in response to brain [[parenchyma]] loss. | ||
=== 2. Non-communicating hydrocephalus === | ==== 2. Non-communicating hydrocephalus ==== | ||
*Non-communicating hydrocephalus, or obstructive hydrocephalus, is caused by a [[CSF]]-flow obstruction (either due to external compression or intraventricular mass lesions) which leads to: | *Non-communicating hydrocephalus, or obstructive hydrocephalus, is caused by a [[CSF]]-flow obstruction (either due to external compression or intraventricular mass lesions) which leads to:<ref name="pmid21928019" /><ref>{{cite journal|doi=10.1186/1743-8454-5-2.}}</ref> | ||
**[[Interventricular foramina|Foramen of Monro]] obstruction may lead to dilation of one or, if large enough (e.g., in colloid cyst), both lateral ventricles. | **[[Interventricular foramina|Foramen of Monro]] obstruction may lead to dilation of one or, if large enough (e.g., in colloid cyst), both lateral ventricles. | ||
**The [[Cerebral aqueduct|aqueduct of Sylvius]], normally narrow to begin with, may be obstructed by a number of genetically or acquired lesions (e.g., atresia, ependymitis, hemorrhage, tumor) and lead to dilatation of both lateral ventricles as well as the third ventricle. | **The [[Cerebral aqueduct|aqueduct of Sylvius]], normally narrow to begin with, may be obstructed by a number of genetically or acquired lesions (e.g., atresia, ependymitis, hemorrhage, tumor) and lead to dilatation of both lateral ventricles as well as the third ventricle. | ||
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**The [[subarachnoid space]] surrounding the brainstem may also be obstructed due to inflammatory or hemorrhagic fibrosing meningitis, leading to widespread dilatation, including the fourth ventricle. | **The [[subarachnoid space]] surrounding the brainstem may also be obstructed due to inflammatory or hemorrhagic fibrosing meningitis, leading to widespread dilatation, including the fourth ventricle. | ||
===Congenital hydrocephalus === | ==== Congenital hydrocephalus ==== | ||
*The [[cranial]] bones fuse by the end of the third year of life. For head enlargement to occur, hydrocephalus must occur before then. The causes are usually [[genetic]] but can also be acquired and usually occur within the first few months of life, which include: | *The [[cranial]] bones fuse by the end of the third year of life. For head enlargement to occur, hydrocephalus must occur before then. The causes are usually [[genetic]] but can also be acquired and usually occur within the first few months of life, which include:<ref name="pmid21928019" /><ref name=":0">{{cite journal|doi=10.1186/1743-8454-5-2.}}</ref> | ||
**Intraventricular matrix [[hemorrhages]] in [[premature infants]] | **Intraventricular matrix [[hemorrhages]] in [[premature infants]] | ||
**[[Infections]] | **[[Infections]] | ||
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**About 80-90% of fetuses or newborn infants with [[spina bifida]] which are often associated with [[meningocele]] or [[myelomeningocele]], develops hydrocephalus. | **About 80-90% of fetuses or newborn infants with [[spina bifida]] which are often associated with [[meningocele]] or [[myelomeningocele]], develops hydrocephalus. | ||
=== Acquired hydrocephalus === | ==== Acquired hydrocephalus ==== | ||
The acquired condition is the result of: | The acquired condition is the result of<ref name=":0" /><ref name="pmid21928019" />: | ||
* [[Infections]]. | * [[Infections]]. | ||
* [[Meningitis]]. | * [[Meningitis]]. | ||
| Line 58: | Line 59: | ||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
!Communicating (non-obstructive) | !Communicating (non-obstructive) | ||
!Non-Communicating (non-obstructive) | !Non-Communicating (non-obstructive) | ||
| Line 64: | Line 64: | ||
!Acquired hydrocephalus | !Acquired hydrocephalus | ||
|- | |- | ||
|subarachnoid/intraventricular hemorrhage | |subarachnoid/intraventricular hemorrhage | ||
|colloid cyst [[Interventricular foramina|'''Foramen of Monro''']] obstruction | |colloid cyst [[Interventricular foramina|'''Foramen of Monro''']] obstruction | ||
| Line 70: | Line 69: | ||
|[[infections]] | |[[infections]] | ||
|- | |- | ||
|[[meningitis]] | |[[meningitis]] | ||
|atresia of '''[[Cerebral aqueduct|aqueduct of Sylvius]]''' | |atresia of '''[[Cerebral aqueduct|aqueduct of Sylvius]]''' | ||
| Line 76: | Line 74: | ||
|[[meningitis]] | |[[meningitis]] | ||
|- | |- | ||
|[[Chiari malformation]] | |[[Chiari malformation]] | ||
|ependymitis | |ependymitis | ||
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|[[brain tumors]] | |[[brain tumors]] | ||
|- | |- | ||
|congenital absence of [[arachnoid villi|arachnoidal granulations]] | |congenital absence of [[arachnoid villi|arachnoidal granulations]] | ||
|hemorrhage | |hemorrhage | ||
| Line 88: | Line 84: | ||
|[[traumatic brain injury|head trauma]] | |[[traumatic brain injury|head trauma]] | ||
|- | |- | ||
|'''[[Normal pressure hydrocephalus]]''' | |'''[[Normal pressure hydrocephalus]]''' | ||
|tumor | |tumor | ||
| Line 94: | Line 89: | ||
|Subarachnoid hemorrhage | |Subarachnoid hemorrhage | ||
|- | |- | ||
|'''brain [[atrophy]]''' | |'''brain [[atrophy]]''' | ||
|[[Dandy-Walker malformation]] | |[[Dandy-Walker malformation]] | ||
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| | | | ||
|- | |- | ||
|post-[[traumatic brain injury|traumatic]] brain injuries | |post-[[traumatic brain injury|traumatic]] brain injuries | ||
|hemorrhagic fibrosing meningitis | |hemorrhagic fibrosing meningitis | ||
| Line 106: | Line 99: | ||
| | | | ||
|- | |- | ||
|psychiatric disorders, such as [[schizophrenia]] | |psychiatric disorders, such as [[schizophrenia]] | ||
| | | | ||
Latest revision as of 13:53, 29 August 2018
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Hydrocephalus Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Hydrocephalus classification On the Web |
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American Roentgen Ray Society Images of Hydrocephalus classification |
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Risk calculators and risk factors for Hydrocephalus classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Ahsan Hussain, M.D.[2]
Overview
Hydrocephalus is classified based upon the underlying cause such as impaired cerebrospinal fluid (CSF) flow, impaired CSF reabsorption, or excessive CSF production.
Classification
- Based on its underlying mechanisms, hydrocephalus can be classified into:[1][2]
- Communicating (non-obstructive).
- Non-communicating (obstructive).
- Both communicating and non-communicating forms can be either:
- Congenital.
- Acquired.
=== 1. Communicating hydrocephalus ===
- The mechanism of hydrocephalus is given below:[1][3]
- It is caused by impaired cerebrospinal fluid resorption in the absence of any CSF-flow obstruction.
- It has been theorized that this is due to functional impairment of the arachnoid granulations.
- Arachnoid granulations are located along the superior sagittal sinus and is the site of cerebrospinal fluid resorption back into the venous system.
- Various neurologic conditions may result in communicating hydrocephalus, including:
- Subarachnoid/intraventricular hemorrhage.
- Meningitis.
- Chiari malformation.
- Congenital absence of arachnoidal granulations (Pacchioni's granulations).
Sub-types of communicating hydrocephalus:
(a) Normal pressure hydrocephalus (NPH):
- NPH is a particular form of communicating hydrocephalus, characterized by enlarged cerebral ventricles, with only intermittently elevated cerebrospinal fluid pressure.
- The diagnosis of NPH can be established only with the help of continuous intraventricular pressure recordings (over 24 hours).
(b) Hydrocephalus ex vacuo:
- It refers to an enlargement of cerebral ventricle
- Hydrocephalus ex vacuo occurs as a result of compensatory enlargement of the CSF-spaces in response to brain parenchyma loss.
2. Non-communicating hydrocephalus
- Non-communicating hydrocephalus, or obstructive hydrocephalus, is caused by a CSF-flow obstruction (either due to external compression or intraventricular mass lesions) which leads to:[1][4]
- Foramen of Monro obstruction may lead to dilation of one or, if large enough (e.g., in colloid cyst), both lateral ventricles.
- The aqueduct of Sylvius, normally narrow to begin with, may be obstructed by a number of genetically or acquired lesions (e.g., atresia, ependymitis, hemorrhage, tumor) and lead to dilatation of both lateral ventricles as well as the third ventricle.
- Fourth ventricle obstruction will lead to dilatation of the aqueduct as well as the lateral and third ventricles.
- The foramina of Luschka and foramen of Magendie may be obstructed due to congenital failure of opening (e.g., Dandy-Walker malformation).
- The subarachnoid space surrounding the brainstem may also be obstructed due to inflammatory or hemorrhagic fibrosing meningitis, leading to widespread dilatation, including the fourth ventricle.
Congenital hydrocephalus
- The cranial bones fuse by the end of the third year of life. For head enlargement to occur, hydrocephalus must occur before then. The causes are usually genetic but can also be acquired and usually occur within the first few months of life, which include:[1][5]
- Intraventricular matrix hemorrhages in premature infants
- Infections
- Type II Arnold-Chiari malformation
- Aqueduct atresia and stenosis
- Dandy-Walker malformation.
- About 80-90% of fetuses or newborn infants with spina bifida which are often associated with meningocele or myelomeningocele, develops hydrocephalus.
Acquired hydrocephalus
The acquired condition is the result of[5][1]:
- Infections.
- Meningitis.
- Brain tumors.
- Head trauma.
- Intracranial hemorrhage (subarachnoid or intraparenchymal) and is usually extremely painful for the patient.
| Communicating (non-obstructive) | Non-Communicating (non-obstructive) | Congenital hydrocephalus | Acquired hydrocephalus |
|---|---|---|---|
| subarachnoid/intraventricular hemorrhage | colloid cyst Foramen of Monro obstruction | intraventricular matrix hemorrhages in premature infants | infections |
| meningitis | atresia of aqueduct of Sylvius | infections | meningitis |
| Chiari malformation | ependymitis | type II Arnold-Chiari malformation | brain tumors |
| congenital absence of arachnoidal granulations | hemorrhage | aqueduct atresia and stenosis | head trauma |
| Normal pressure hydrocephalus | tumor | Dandy-Walker malformation. | Subarachnoid hemorrhage |
| brain atrophy | Dandy-Walker malformation | spina bifida | |
| post-traumatic brain injuries | hemorrhagic fibrosing meningitis | meningocele | |
| psychiatric disorders, such as schizophrenia | myelomeningocele |
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Rekate HL (October 2011). "A consensus on the classification of hydrocephalus: its utility in the assessment of abnormalities of cerebrospinal fluid dynamics". Childs Nerv Syst. 27 (10): 1535–41. doi:10.1007/s00381-011-1558-y. PMC 3175041. PMID 21928019.
- ↑ . doi:10.1186/1743-8454-5-2. Check
|doi=value (help). Missing or empty|title=(help) - ↑ . doi:10.1186/1743-8454-5-2. Check
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|doi=value (help). Missing or empty|title=(help) - ↑ 5.0 5.1 . doi:10.1186/1743-8454-5-2. Check
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