RT Book, Section A1 Fuchs, Susan A2 Tenenbein, Milton A2 Macias, Charles G. A2 Sharieff, Ghazala Q. A2 Yamamoto, Loren G. A2 Schafermeyer, Robert SR Print(0) ID 1155297890 T1 Hydrocephalus T2 Strange and Schafermeyer's Pediatric Emergency Medicine, 5e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259860751 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1155297890 RD 2024/03/28 AB Hydrocephalus refers to the excess accumulation of cerebrospinal fluid (CSF). Most cases result from congenital or acquired obstructions to the flow of CSF from the brain to the spinal canal.Infants with hydrocephalus are often diagnosed on routine examination by finding head circumference disproportionately large for age, or splitting of the cranial sutures.Older children with hydrocephalus will usually complain of headache, which is often progressive in nature, worse in the morning, awakens the patient from sleep, and is exacerbated by lying down or straining.It is imperative to begin treatment in the unstable patient before herniation occurs. Patients who are lethargic on presentation, those with a Glasgow Coma Scale <8, or those who deteriorate in the emergency department are intubated following rapid-sequence induction procedures and ventilated to maintain PaCO2 at 35 torr. If there are signs of herniation such as unequal pupils, fixed and dilated pupils, or posturing, mild hyperventilation (30–35 torr) can be helpful on a short-term basis.Patients who do not respond with an improved mental status after intubation and controlled ventilation may benefit from therapy with mannitol or 3% NaCl solution (hypertonic saline).After the patient is stabilized, a computed tomography scan or magnetic resonance image of the brain is performed to define the lesion and plan definitive treatment.