 Hi, welcome to nursing school explained. Today's topic is hydrocephalus. So let's take a look here. So hydrocephalus is an imbalanced production and absorption of cerebral spinal fluid. And remember that cerebral spinal fluid is in the brain and also flows all the way down into the spinal cord. And it's usually contained within the ventricles of the brain, but when there's too much cerebral spinal fluid, the ventricles inside the brain will dilate. And when that happens, the brain gets compressed. And I wrote down here these three terms. So basically in our cranial cavity, we have three components. We have the brain, we have blood inside the blood vessels, and we have cerebral spinal fluid. And usually that's all contained in our skull. So this is a nice protective mechanism to protect the brain blood blood and cerebral spinal fluid. But when there's now increased production of cerebral spinal fluid, there's an imbalance between these three structures or compartments within the brain. And so then something has to give. And if the cerebral spinal fluid gets larger and larger, the brain gets compressed against the skull. Now hydrocephalus is usually something that occurs in infants or children. And the good thing about infants is that their skull is not completely fused yet. So they have the anterior and posterior fontanelles open still. And so when the cerebral spinal fluid, there's an increased production, then it had the skull, there's basically room for that to expand. And so then you will see fontanelles that are bulging because now the cerebral spinal fluid is causing increased intracranial pressure. And these fontanelles will kind of allow the expansion of the cerebral spinal fluid. So when there's open fontanelles, then the skull will basically enlarge. You will see the bulging fontanelles but then over time because the skull, the bones of the skull are still kind of formable, pliable. It will result in hydrocephalus. So their skull cavity, their whole head will get bigger. Now that's the advantage of having open fontanelles, but if the fontanelles are closed, there's no way for the skull to expand. Everything is already set. And then the patient will exhibit signs and symptoms of increased intracranial pressure, which will be all kinds of neurological signs. So what causes hydrocephalus? It's either congenital. So that can be either by tumors that are causing increased cerebral spinal fluid production or chiarimal formation. And chiarimal formation is a complication of spinal bifidocystica or myeloma ninjoseal, which is a normal tube defect. And keep in mind that in embryonic development, the embryo is basically just a tube that eventually starts to develop and elongate and develop into the different parts. And this neural tube can have a defect called spinal bifidoma or myeloma ninjoseal, where there is then at the level of L5S1, kind of like a sac-like protrusion. And if this protrusion happens, the brain kind of gets sucked down into the spinal cord, and this is called a chiarimal formation. And in turn, cerebral spinal fluid will increase causing the increased pressure in the cranial cavity and then the enlargement of the skull with all those complications. Now, another cause is a quiet hydrocephalus. And this might be due to neonatal meningitis, as well as subarachnoid hemorrhage. So bleeding in that intracranial cavity. So in this case, the cause would be the actual blood taking up more space here rather than the cerebral spinal fluid. But nonetheless, the cerebral cavity will expand. Now, how do we diagnose this? That's why we measure head-to-conference in infants at every visit. And sometimes it's pretty obvious already if the patient has spinal bifida that is detected during the prenatal checkups or some other abnormalities that occur, but head-to-conference is number one. And then certainly a CAT scan or MRI to help get some pictures of the exact structures of the brain to see what might be causing it. Or an ultrasound can also be helpful in transcranial ultrasound, as well as the lumbar puncture, which will have to detect the subarachnoid hemorrhage. Now, the treatment goal for hydrocephalus is to decrease that CSF accumulation so that the skull cavity doesn't get enlarged, which helps to decrease disability and death. And the way this is accomplished is by a ventricular peritoneal shunt, or also called a VP shunt. And bear with me here, I'm not the greatest drawer there is, but I drew out our child here. And the VP shunt basically means there's a tube placed inside the ventricle of the brain that's then threaded down through one of the blood vessels of the neck, all the way down into the abdomen. And basically the contents are just emptied, indeed, into the abdominal cavity, within the body just reabsorbs that CNF, allowing CSF allowing it to drain and not accumulate in the brain. And that's usually done in smaller children. If children need a shunt for hydrocephalus and they're a little bit older, this might be a ventricular atrial shunt. So basically again, stemming from the ventricles of the brain, and that shunt now ends up inside the right atrium, when a CSF just enters the brain, sorry, the bloodstream, and then is circulated throughout the blood and then reabsorbed by the body. Now, as you can imagine, any time you have a surgical procedure that involves placing a shunt inside the brain, there's a high risk for infection. So complications of any, either one of these shunts are infection or blockage. And keep in mind, these shunts are usually there for a lifetime. So you might even see adults that have an EP shunt or VA shunt implanted, and now they're maybe brought to the hospital for altered level of consciousness. And then your thoughts should be maybe there's a blockage or an infection of that shunt. And if the shunt is now blocked, that CSF again is accumulating, causing the brain to be compressed, causing altered level of consciousness and neurological deficits. And the shunt also might need to be changed, which means that there's a surgical procedure involved. And again, whenever we have a surgical procedure involved in the central nervous system, we always have to be concerned about infection. So thank you for watching this video on hydrocephalus. If you would like more information on spinal bifida, there's a separate video about that. Thanks for watching Nursing School Explained.