Medical Overview and Epidemiology

Hydrocephalus develops as an isolated congenital disorder in approximately 1 out of 1,000 births and leads to an enlarged ventricular system in the brain and associated expansion of the ventricles, displacement of adjacent brain structures, and increased intracranial pressure (Avellino 2005). Obstruction involves the lateral, third, and fourth ventricles; the foramen of Monro; and the cerebral aqueduct. The causes of the obstruction vary by location, and the signs and symptoms vary by age. It is the mechanical distortion of brain structures, causing altered cerebral blood flow and changes in metabolism and neurotransmission, that leads to the development of psychopathology (Braun et al. 1997; Caner et al. 1993: Catalan et al. 1994; Da Silva et al. 1994; Del Bigio et al. 1997; Tashiro et al. 1997). Subsequent reductions in brain mass and cortical mantle affect the parietal and occipital regions, a problem that is particularly prevalent in younger patients (Dennis et al. 1981; Fletcher et al. 1996; McAllister et al. 1991). Possible etiologies include congenital disorders like myelomeningocele and associated Chiari malformation, aqueduct stenosis, and DandyWalker syndrome. Hydrocephalus can also be acquired through prematurity and intraventricular hemorrhage, meningitis, traumatic brain injury, tumors, and infectious diseases. There are no nonsur-gical interventions that are effective in the treatment of hydrocephalus. Surgical options involve either nonshunting or shunting procedures.

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