A Question About Hydrocephalus

[jeshicuhx3]

Hello Nurses!

I have a question for a case study that I am doing for my A&P class...

The case is about a 3 month old child with Hydrocephalus..

the question asks if there is an advantage or disadvantage of the fontanels still being present, did it make the problem less dangerous or more dangerous?

Thank you all of your help!

[meanmaryjean, DNP, RN]

A definite advantage. Think about pressure building up in a confined space vs. having a 'pop-off' valve.

[jeshicuhx3]

That's what I was thinking... I put that in an adult the excess fluid would have nowhere to go, causing more damage and requiring a shunt. That would be correct, right?

[meanmaryjean, DNP, RN]

They both require a shunt- the adult could end up brain dead a WHOLE lot faster than the child.

[KelRN215, BSN, RN]

That's what I was thinking... I put that in an adult the excess fluid would have nowhere to go, causing more damage and requiring a shunt. That would be correct, right?

An infant with hydrocephalus still requires intervention (not necessarily a shunt, there are procedures to treat hydrocephalus without a shunt). The difference is, there is no extra space in the skull of an adult. Pressure will build up more quickly and the adult will herniate without immediate intervention. An infant with an open fontanelle has room inside their skull because the bones haven't fused yet. This is why you measure the head circumference of an infant with hydrocephalus- as this is likely to increase before the infant develops symptoms. If you don't treat an infant with hydrocephalus their head will grow HUGE.

[Esme12, ASN, BSN, RN]

What is one of the signs that a baby has hydrocephalus? A bulging fontanelle. This is visible on a baby long before neurological symptoms/deficits occur. It's kind of like a built in intercranial pressure monitor.

Why would knowing there is a problem sooner be an advantage?

[nurseprnRN, BSN, RN]

An infant with hydrocephalus still requires intervention (not necessarily a shunt, there are procedures to treat hydrocephalus without a shunt). The difference is, there is no extra space in the skull of an adult. Pressure will build up more quickly and the adult will herniate without immediate intervention. An infant with an open fontanelle has room inside their skull because the bones haven't fused yet. This is why you measure the head circumference of an infant with hydrocephalus- as this is likely to increase before the infant develops symptoms. If you don't treat an infant with hydrocephalus their head will grow HUGE.

I am old enough to remember seeing children like this in state hospitals when I was a student. A ten-year-old in a crib with a head the size of a bushel basket (yep), too heavy to lift it off the mattress, with toothpick limbs from disuse is something you never forget. Fortunately we don't see this much except in very primitive settings anymore.

[Esme12, ASN, BSN, RN]

I am old enough to remember seeing children like this in state hospitals when I was a student. A ten-year-old in a crib with a head the size of a bushel basket (yep), too heavy to lift it off the mattress, with toothpick limbs from disuse is something you never forget. Fortunately we don't see this much except in very primitive settings anymore.

I remember some of those kids....heartbreaking...

[NicuGal, MSN, RN]

We still see some of those babies...the parents sometimes opt to not shunt as there is little brain matter. The few with extreme hydrocephalus that I have seem are the sweetest little things

And yes, having an open fontanel and sutures that have not fused are very beneficial. Some

Kids with mild hydro we will watch...head circ every day and head ultrasounds every 2 weeks if necessary.