eMedicine Specialties > Neurosurgery > Trauma

Hydrocephalus: Workup

Author: Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago
Coauthor(s): Kamran Sahrakar, MD, Clinical Professor, Department of Neurosurgery, University of California-Davis; Dachling Pang, MD, FRCS(C), FACS, Clinical Professor of Neurosurgery, Chief of Pediatric Neurosurgery, University of California Davis School of Medicine; Chief, Regional Center for Pediatric Neurosurgery, Kaiser Permanente Hospitals of Northern California
Contributor Information and Disclosures

Updated: Dec 19, 2007

Workup

Imaging Studies

  • CT scan of the head delineates the degree of ventriculomegaly and, in many cases, the etiology. When performed with contrast, it can show infection and tumors that cause obstruction. It also helps with operative planning. Ventricles are usually dilated proximal to the point of obstruction. In pseudotumor cerebri, the CT scan findings are usually normal.
  • Perform MRI scan of head in most, if not all, congenital cases of hydrocephalus. This delineates the extent of associated brain anomalies such as corpus callosum agenesis, Chiari malformations, disorders of neuronal migration, and vascular malformations. Some tumors, for example the midbrain tectal gliomas, only can be detected with this study. T2-weighted images can show transependymal flow of cerebrospinal fluid (CSF).
  • Fetal and neonatal cranial ultrasound is a good study for monitoring ventricular size and intraventricular hemorrhage in the neonatal ICU setting. Certainly, prior to treatment, perform other imaging studies.

Diagnostic Procedures

  • Lumbar puncture can be used to measure intracranial pressure, but it should only be performed after imaging studies rule out an obstruction. A diagnostic high-volume lumbar puncture in normal pressure hydrocephalus can assist in making decisions regarding shunting. Spinal fluid can show the type and severity of infection (see the eMedicine article Meningitis).

More on Hydrocephalus

Overview: Hydrocephalus
Workup: Hydrocephalus
Treatment: Hydrocephalus
Follow-up: Hydrocephalus
References
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References

  1. Hahn YS, Engelhard H, McLone DG. Abdominal CSF pseudocyst. Clinical features and surgical management. Pediatr Neurosci. 1985-1986;12(2):75-9. [Medline].

  2. Aronyk KE. The history and classification of hydrocephalus. Neurosurg Clin N Am. Oct 1993;4(4):599-609. [Medline].

  3. Black PMcL, Ojemann RG. Hydrocephalus in adults. In: Youman JR, ed. Neurological Surgery. 3rd ed. Philadelphia, Pa:. WB Saunders Co;1990:927-944.

  4. Gleason PL, Black PM, Matsumae M. The neurobiology of normal pressure hydrocephalus. Neurosurg Clin N Am. Oct 1993;4(4):667-75. [Medline].

  5. McLone DG, Partington MD. Arrest and compensation of hydrocephalus. Neurosurg Clin N Am. Oct 1993;4(4):621-4. [Medline].

  6. Milhorat T. Hydrocephalus: Pathophysiology and Clinical Features. Neurosurgery. 1996;3:3625-3632.

  7. Pang D, Altschuler E. Low-pressure hydrocephalic state and viscoelastic alterations in the brain. Neurosurgery. Oct 1994;35(4):643-55; discussion 655-6. [Medline].

  8. Sainte-Rose C. Hydrocephalus in childhood.In: Youmans JR, ed. Neurological Surgery. Philadelphia, Pa:. WB Saunders Co;1996:890-926.

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Further Reading

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Keywords

hydrocephalus, abnormal rise in cerebrospinal fluid volume, abnormal rise in cerebrospinal fluid pressure, CSF, imbalance of cerebrospinal fluid production and absorption, spinal bifida, congenital hydrocephalus, acquired hydrocephalus, aqueductal stenosis, intracranial tumor obstruction, intracranial trauma, intracranial hemorrhage, intracranial infection, disorders of cerebrospinal fluid production, disorders of cerebrospinal fluid circulation, disorders of cerebrospinal fluid absorption, cerebrospinal fluid diversion, third ventriculostomy, normal pressure hydrocephalus

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Contributor Information and Disclosures

Author

Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago
Herbert H Engelhard III, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, American Society for Cell Biology, American Society of Clinical Oncology, Chicago Medical Society, Congress of Neurological Surgeons, Illinois State Medical Society, Society for Neuro-Oncology, and Society for Neuroscience
Disclosure: Nothing to disclose.

Coauthor(s)

Kamran Sahrakar, MD, Clinical Professor, Department of Neurosurgery, University of California-Davis
Kamran Sahrakar, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Medical Association, California Medical Association, Florida Medical Association, and Nevada State Medical Association
Disclosure: Nothing to disclose.

Dachling Pang, MD, FRCS(C), FACS, Clinical Professor of Neurosurgery, Chief of Pediatric Neurosurgery, University of California Davis School of Medicine; Chief, Regional Center for Pediatric Neurosurgery, Kaiser Permanente Hospitals of Northern California
Dachling Pang, MD, FRCS(C), FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, Congress of Neurological Surgeons, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Duc Hoang Duong, MD, Associate Professor, Director of Neuroscience Physician Assistant Program, Departments of Neurological Surgery and Neuroscience, Epilepsy Center, Charles R Drew University
Duc Hoang Duong, MD is a member of the following medical societies: American Neurological Association and North American Skull Base Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ryszard M Pluta, MD, PhD, Associate Professor, Neurosurgical Department Medical Research Center, Polish Academy of Sciences at Warsaw, Poland; Senior Researcher, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH
Disclosure: Nothing to disclose.

CME Editor

Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago
Herbert H Engelhard III, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, American Society for Cell Biology, American Society of Clinical Oncology, Chicago Medical Society, Congress of Neurological Surgeons, Illinois State Medical Society, Society for Neuro-Oncology, and Society for Neuroscience
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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