Chapter 10

Etiology
(Congenital Hydrocephalus)
Hydrocephalus develops when there is an imbalance between CSF production and absorption.
The imbalance can cause CSF buildup in the ventricles of the brain and causes it to dilate, when
it does dilate, it pushes the brain towards the skull, increasing brain compression which could
result in increased head circumference if the cranial sutures are open (which is common in
newborns). (McKinney, S. et.al, 2009)

Predisposing Factors

Factor Presence Rationale Justification

Congenital Absent It depends on the site of There were no tumors

Tumors obstruction. Tumors if located found on Patient
near the subarachnoid process, Megamind’s x-rays and
where most of the cerebrospinal charts. Therefore his
fluid is absorbed in the blood condition was not
circulation, can cause a caused by a tumor.
blockage of the absorption
process of the cerebrospinal
fluid. (Leifer, 2015)

Myelomeningocele Present There are no known cause of The presence of

Myelomeningocele but studies myelomeningocele was
have shown that it is related to confirmed after birth and
the mother’s intake of folic acid was ruptured 4 hours
before and during pregnancy. later. The mother
Folic acid is a key component for confirmed her lack of
brain and spinal cord folic acid intake during
development, mothers should her first 3 months of
take at least 0.4 mg of folic acid pregnancy.
daily. Maternal folic acid
deficiency has been strongly
linked with neural tube defects.
Nearly 80% with
myelomeningocele develop
hydrocephalus as a result of a
Chiari type II malformation
(Arnold-Chiari malformation).
(McKinney, 2009)

Arnold-Chiari II malformation

Extensive deformity of the

posterior fossa and its structures
 is associated with Arnold-Chiari
II malformations. The brainstem
has an abnormal disposition with
respect to the midbrain and the
tentorial hiatus, the posterior
fossa has smaller capacity than
usual, the fourth ventricle is
displaced caudally, and the
cerebellar tonsils through the
foramen magnum are
significantly prolapsed. These
anatomic factors all contribute to
the impairment of CSF
circulation. (Sgouros, MD,
2017)

Aqueductal Present From the word “Aqueduct” it His aqueductal stenosis

Stenosis pertains to a canal where water
passes, and “Stenosis” is used
when a passage way is
narrowed. Aqueductal stenosis
is the narrowing of the canal that
connects the third and the fourth
ventricle, the aqueduct of
Sylvius. If the canal narrows, it
would impede the circulation of
the cerebrospinal fluid towards
the other parts of the ventricles
thus producing a back flow
which can result in the
enlargements of the lateral
ventricles. (Leifer, 2015)
was diagnosed through
CT scans of the head
which yielded an
impression of
Congenital
Hydrocephalus r/t
aqueductal stenosis.
Aqueductal stenosis
was possible because
of the presence of
infection which causes
inflammation of the
ventricles thus resulting
to narrowing of the
aqueduct.

Congenital Absent Congenital Arachnoid cycts are Baby Megamind was

Arachnoid Cysts fluid-filled sacs present at birth not diagnosed with
but are not considered as congenital arachnoid
tumors. It may be likely caused cycts and the doctors
by a split of the arachnoid have not found any
membrane presence of cysts nor
tumors in the scans they
They are four times more have conducted.
common in boys and diagnosed
with CT and MRI scans.The
treatment would be drainage or
the use of a shunt to drain the
fluid. (Johns Hopkins Medicine,
2017)

Lack of Prenatal Present Studies have shown that a The mother admitted
Care decrease of folic acid intake that she had not taken
during pregnancy can result in any folic acid during her

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 defects of the neurological first 3 months of
system. This can also contribute childbearing which
to spina bifida. greatly contribute to the
formation of
(McKinney, 2009) myelomeningocele.

Precipitating Factors

Opportunistic Present A series of infections due to open Staphylococcus

Pathogens myelomeningoceele can contribute aureus and Klebsiella
and may also lead to the infection were
inflammation of the membranes present in the CSF
that line the cerebrospinal fluid GSCS lab test.
pathway. If the membranes are Medications such as
inflamed it can cause an antibiotics and
impediment of the cerebrospinal antipyretics where
fluid and results in the hypertrophy prescribed to prevent
of the ventricles. (Sgouros, MD, further infection.
2017)

Poor Wound Care Present Areas like the ruptured The mother stated
myelomeningocele site is prone to that after the
infection especially if the infant is myelomeningocele
not properly cleaned. There is a ruptured, the wound
possibility of cross contamination dressing would often
between infant’s fecal deposits with be covered with fecal
the open wound thus leading to deposits which had
infection. (Sgouros, MD, 2017) caused the infection.

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