Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

like often and everyone a thank you for joining or SRC session is evening. We just wait for a couple more minutes for people to join before we start going through the slight side. The teaching session sent key. All right, seeing that it's already five past the hour. I just quickly speak through the introductory slights. I'm so welcome over on today to the walls in Dundee s a C section to be about who we are. So you're basically a bunch of medical issues and so really passionate about neurosurgery. The UK branch off 10 days a size. He was found a girl early off 2010 to 1. Say, was it done today? So if, like, global society, it was founded by Professor Salim up to rob um, about that kids ago on it since branch up to over 30. Issue and clubs were white. A little structure. We're start shortly and put on two hour. Sure and teacher on there. Hopefully be time for a short period a session at the end and to receive the certificate, please feel. Please remember to complete a post slc feedback for we should be sent out to you by email. So do you keep an eye on that? To become a teacher, you just need to fear in a form or Scandishake your coat on. Be highly encourage it. It's a good opportunity to be your CV transition. You're taking skills which are important when you become a doctor and our post all these coats in the group chair on quickly about a lab in a ruse. Please leave off crushings in the chart that goes through them at the end on Do Try a War, interrupting the session so you can go a Smith less possible to keep our in the chart for any relevant links. Teo, Have you enjoyed today's session? Only infants or hydrocephalus by Elias, Who's from cranberry? All right, of stop sharing is great now. Hello, guys. Yeah. So today, our Tokars about infantile hydro part of stuffiness on last. Bodine and I'm 1/4 year medical student. Queen Mary University. What? I want you guys to get out of this talk today is to to understand what a normal ventricular anatomy is to understand what what hydrocephalus is and why. Why? Why is it bad on? Then I'll go off some off the off the off the courses for hydrocephalus, mainly in infants on. I'm going to briefly, briefly, briefly explain some of the ways that we can treat hydrocephalus. Does this cause there's gonna be a very long talk of our animation. All surgery, infections, first or toe to understand war, War, war hydrocephalus is we need to understand what the origin and this and the circulation off the cerebrospinal fluid. So the CSF is mainly produced by the cord plexus up to 80% off. This year's off production is from this site. On what? The CSF is basically an ultra filtration off the blood through the blood and CSF barrier. What does the CSF you protect? It cushions nourishes, and it can remove the waste of from from the brain we usually produce around 20 miles an hour or roughly half a liter a day on me And the aim off this off. This, uh, production is to try and recycle this year Cephaelis it five times a day. When it comes to be a two units or infants, Thie production rate is is around two miles per kilo. Uh, I didn't find much. Resource is between 60 weeks and five on five years. So this this area is no small clear. What is the the the ventricular? And actually so this is a side view that that's the lateral ventricle. And there's another natural ventricle here. I want you to remember that this is the anterior horn. This is the occipital home, and these are the didn't pull home off the off the off the lateral ventricle, the lateral ventricles meet at the forearm, it off off Monroe and they train into the third friend into the third ventricle on, if you on if you guys were take. Just one thing from this life is that this is the cerebral act. Aqueduct on. You will know this house how important the cerebral a quack at that could happen off the ensure showing these slots. But after the cerebral act, there are off the cerebral aqueduct, the CSF drainage, the fourth ventricle, which can leave it through the lateral aperture. The median aperture on this on the central canal. So mention here on now, I'm just going to show you the same image without the the hours and the and the names. And I want you guys to just try and remember where the cerebral aqueduct this and where the last ventricles are? That's the cerebral aqueduct. That's the last frontal occipital anti hold. Okay, so now that we've spoken about the production off the CSF on the ventricular anatomy, now let's let's let's look at the flow off this off this yourself. So it's it's it's produced by the core plexus. Mainly, it fills the ventricles. It slows down for another one row. If you remember, that's third ventricles on. That's that's the cerebral act that's the cerebral aqueduct fourth ventricle on. Then it flows to the sub bracket. Would space where, where it's drained by the Iraqi, would be cranials into the into the venous system? The arachnoid the Granules are are one way one way valve, so only allows 30 CSF believe it doesn't allow the blood to back into the seven rapid today's okay, so now that we've spoken about all of this, war is hard 100 hard hydrocephalus. In simple terms, it's just accumulation off water in the brain. Basically, it's accumulation off the cerebral spinal fluid abnormally in the ventricles. On what happens is that the ventricles they start enlarging, which can compress on the on the only on the brain and it can cause hung on handy a shit. Uh, who gets hydrocephalus has two weeks, usually the infant slash me the knee units. I remember reading somewhere that most of the cases in the pediatric population will present before the age of two, often years on, then did the the elderly population than to get a other peak off off, off, off hydrocephalus. How common is hydrocephalus in the pediatric population is the most common childhood brain disorder with an incident with means your 0.1 to 3.2000 births. So in 1000 infants on the ah, the disease burden is tired through throughout throughout, through through throughout life. Very rarely, you can become shown dependent. Shunt is the way they treat hide the hydros hydrocephalus and very rarely can become showing dependent. So in in independent on how can you classify hydris hydrocephalus? It could be acquired with developmental. It could be obstructive or communicating and condition drama on a nose syndrome. Now how how, with an infant to present with with harder cephalous. The main thing that I want you guys to remember is that basically it's raised, I suppose. So You. So you can for the rest of off the symptoms of day, based on the fact that his race race ICP, so you would have a new greasing head head circumference usually tends to be a rapidly increasing head circumference as well. If the child's they still have fontanel's, it would be bulging, functional, as you can see scalp veins on sunsetting off the eyes, which this picture shows so that I would have been normally aligned this way. But in the sun setting I it's a downward case. You can find some sleepiness and some irritability as well. So, Sean, that present to you like this, what would you do? You would scan to try and find out what's what's what's happening on. I just included this. This image, although it is a five boxes brain, is just to show you guys who walk a nun hydro none hydrocephalic a brain would that would look like on That's what a severe hydro, hydro selfless it look like. Basically, at this stage, the brain is very compressed or snow there anymore on. That's just a lower city cops, and that's a mother case off in the unit with with her selfless If you guys remember, these are the lateral ventricles. Frontal horn is accepted. Horns on my system will hold here and you got some. Well, I said, If you remember this cerebral aqueduct, that's why because I because I quit up. This is the stenosis is very common on the cerebral act that the eighth come, a compression slashes stenosis or narrowing off the cerebral aqueduct. Is that what's called because if intraventricular blockage and if you block the ventricle, Ozu will goes high high hydrocephalus. What's the pipes off? Aqueduct? Compression or blockage or stenosis? It could be compression mainly by humans. All the structures or convene on tumor. Aqueduct Still stenosis? I just included this. For your own knowledge wise, you don't have to remember this one, but this is the Russells. This is the muscles of classifications off non few more lack without stenosis, and it's mainly based on the history on the Histopathology. Stenosis was just narrow when you can have for King was split into more than one channel, and some of the challenges can have it that day, and you can have septum formation by a gliotic membrane overgrowth on a difference with your sister is where the Lumen off the aqueduct is lined by glial cells now. And this just picture to show you wore a laugh without stenosis, stenosis would look like and that's what a narrow those nose one look like. Thus, for example, an image off hydrocephalus on That's where the site off the blockage or stenosis is. And that's with cerebal like Well, that that's the fourth ventricle, said ventricle, and address this story black. With that on. This is another example Dust against the hydrocephalus or just I don't know the 70 severity of this one, but that's had hydrocephalus on. That's where you have another block, the ventricle for financial concern. We have fourth ventricle on. That's where the narrowing Saslow blockages and now the second cause off. Hydrocephalus is forced hemorrhagic hydrocephalus, and it's the most common cause of acquired hydris hydrocephalus it them still primarily happen in in, uh, and prion pressure babies on. That's mainly because if the Germinal matrix is very vulnerable and still very metabolically active on in premature need, he knew units that the lungs are are fluctuating in terms off in terms of oxygenation which also all these the BP and it can cause interest in trouble. Trouble trickle Hamlisch. How with a hammer in the ventricle Because, uh, hydrocephalus Well, it can cause fibrosing off the off here off the rack, Annoyed or or the major players or the cells that on this in turn impedes B CS a flow am resorbtions. I get accumulation supposed to magic. Hydrocephalus has been on the decline, and that's mainly because of the improved clarity, natal medicine and introduction off cortical steroids. On the ends of the incidents, if the body weight is between 1.51, Q is 12% and increases after 20%. If the body weight is less so, it's less so. It's less than 1 kg now, 50%. So if 15% off off. Ah, the babies that develop intraventricular hide heart So Intraventricular hammers will develop all summarized contributor dilation more than 50% off the babies that have posthemorrhagic matriculate violation require for CSF diversion, all might die. CSF diversion is the way that you treat hydrate hydrocephalus, which is our the shunting or in this end, this and discovered third ventriculostomy determine post post in Russia. Quite the cephalous tends to be used when there is a progressive, intricate and enlargement, and there's an on increase in head. Now. How would you classify Intraventricular Hampshire? Because we've mentioned that they are the most common cause of acquired hydro hydro hydro high hydrocephalus. So it's important to know how you're gonna classify the severity of them before we go into this severity. Is this just an abnormal ultrasound to show you our normal ventricular anatomy in a premature baby would look like That's the court date passed the thalamus, and that's where the quarter plexuses now in terms of severity, is one we. Where the hammers is just restricted to the Matrix, too, is where extends into the ventricles vessels less than than 50% of them and three is where there is extension and violation off the off. Eventually extension off the Hamlisch and dilation off the ventricles. On Type four is where, where there is basically an intraventricular hemorrhage. But there's also per ankle involvement on If you look at the mortality and incidents D, least it's a very one. Is is the most common found thankfully, but then the least common one is the most severe one, and we'll talk. A weight jumps to 36 more past in some some images off grade 1 to 2. Grade three intra and travel trickier. Hemorrhage is, if you can see here, that's I believe, is the German Matrix, with some hemorrhage is that's where there's a blood clot. Now this area shows book clots. The number nine here shows a normal cold plexus. They can see this country clear violation. Remember, there's those extension into in denial. Ated. Ventricles lasted large, and that's entirely ventricles. That's the core of plexus now. Food the most severe one or 22 images to show you guys that's blood on that would offend the normal ventricle. And there's extension into the brain. Parenchyma. Same here. That's where the ventricle would have been that there's extension into the brain for ankle. So that's that's a great for hemorrhage insurance. Uh, the second, the sort of the third. Now, the third cause would be a urology deep defect, which is a failure off the end off the new off the new off the neurons you do closer properly during development. Uh, the incident does vary by region called various between 6.9 to 21.9 in 10,000 births on approximately 70% of patients with a severe form off, neural tube defects will develop hydris hydrocephalus on 80% of patients who have mild of millions. Your seat and I'll show you a picture of this is a bit will develop hydra hydrate, hydrate, hydrate, hydrocephalus on If you guys remember what While highlighting earlier the aqueduct stenosis, a study found that 80 82% of patients who have mild of men, men and you see you also had after the stent stenosis. How how would you manage neural tube defects? You need to close the neural tube defects surgically, and you need to pull even trick your partners come for the heart for the hydrocephalus. I was reading a study where they are, where they tried to sessions, passes one surgery off off fixing the neural tube defects that the two surgeries were closure and then reject permission. And there was no different than me. There was no significant difference in in that in outcomes. That's the different parts off neural tube defects. Well, I I guys want you to remember for this talk is insofar a sealed, and this is going to show up on ah, different types off and off. Spinal new tube defects. That's then the mile of energy. A seal the most. Everyone. That's just the meningitis ear. That's a close final distract is, um on. That's fine. A big clock. Okay, so this is normal spine on. This should be normal spine. But those extension here on this is an example off a mile of meningitis, and this is also normal. Fine around those assistant evident off in your tube defects on This is an image off a mile a minute, you see, and now have hydrocephalus turns for this one. Varied a lot by country and by study off really varied. Between 30 60 to 60% of cases are post post infection, which means that there was an infection in the brain. And how does this cause hydris? Because high interests hide the settle ist the inflammation, creates an fusions, have fibrosis in arachnoid marker and in the village eyes and my clothes ventricle likes which overall impedes the CSF. So circulation some of the causes off what's infective hydrocephalus is bacterial meningitis. It should be close meningitis stops, plasmosis, viral meningitis and encephalitis. I believe these are in order off most common police common that would cause high dose. Now, what's the criteria to diagnose sports? Effective hydrocephalus. One is that there should not be any previous history. Off, off, Hydrate Off the cephalous there should be a preceding either from a febrile illness or a seizure on gone imaging. There should be a form off, then trickle like this, scarring or look on loculations. I remember the the Loculations guys because you're going to see it now. That's just very evident. Off course. Infective hydrocephalus on. Now we still have two more. And then I'm sure you guys images and I want to try and guess the Central. So in terms of posttraumatic hydrocephalus we have approximately 4% of all patients would have drawn require for CSF that diversion. And if you remember, CSF diversion is one of the ways that you treat hydro, hydro, hydro cephalous. Now I got this sentence it from the international society off the the African you associate the ESPN. So I believe the 4% of all patients relates to pediatric population on the race off hydrocephalus I think this is in all populations increase up to 36% if the FDA compressive craniotomy was was used because after post, because after a traumatic brain brain injuries, you can guess this was swelling that you need to, uh, managed by performing any concerns credit on after the trauma there would be there would be a progressive accumulation off, CSFB told Hydro Dynamics Obstructions. This is a case of hydrocephalus on There is on obstruction here. I believe this was because of a clock. That's where the quote have been on. This image shows that there's some severe built in the source on top of the variation here, which was still here. But now the the the patient went into get and in this topic, third century ventricular story where we would create another way to drain the CSF on. Lastly, in terms of the courses that di di listen in the first half is tumor related hydrocephalus on. Basically, it's a tumor that's that compressing on the on the outflow tracks very simple terms that would cause obstruction on violation off the ventricles in the pediatric people in a pediatric population, the posterior fourchette tears are the most common 80% Sorry. 88 85% of the pediatric population where the posterior fossa it you will develop a degree of five of hydrocephalus 20 to 30 will develop a permanent form of 100 off cephalous. I eat. It's not treated when you take the tumor out on this is a case off an astrocytoma that's compressing on the, uh, cerebral aqueduct on that's dilated ventricles. So now if you guys don't take a quick break, you can just let me know on the chart so I can monitor the chart for you on. Otherwise I would be showing you images on I would like you to guys your stride and guess the more striking future and this image. And then I will let you know what syndrome or what malformation Is this Because, uh, I did under the project on hydrocephalus on. I didn't appreciate these until I read them Triaminic. You guys like realize I appreciate the other. My information's or the other striking feature is before you know what what this infamous on some a few might might know that already. Okay, so there's no mention of breaks and shooting you guys would like me to keep going. Yeah, so that's that's the same patient on Waters. The most striking feature apart from the dilated ventricles here slash hydrocephalus here. Well, the striking feature Do you guys notice? If you write in a chat, you can write that up and look at the shop. Otherwise, you can think about it and I'll let you know in a bit. Okay, so that's That's where the fourth ventricle was spent to be. That you can see it's very dilated on. This is a remnant off pieces off the cerebellum for Ms and it's this place. So clearly, basically all another thing would be cephalopod. This dislocation or off the cerebellum for ms on us was meant to be the fourth ventricle. That's very enlarged. So what would this be? This'll would be a dandy walker malformation on. I'm going to go back to the previous slide to show you what will work the signs off that, and I'll explain a bit more should that spend to be the cerebellum can't orient on as that's the remnant off the cerebellum for Ms which is displaced. So in a cephalic for direction I towards the head that was meant to be the fourth ventricle on That's hypoplasia slash a genesis off the cerebellum, the furnace, which was meant to be here. You also get a, uh, I'm normally shaped ventricles. So what is done? The walk of my formation, it's It's the most common possibility for so and normally and accounts for 1 to 4% of hydrocephalus cases. Ah, I was I was going through some studies, and I noticed, too. So he's agreed that the 100% of patients with then you open my formacion tend to get hydrated hydrocephalus terms of firm in a genesis. It was 88 cents on several Bella Hypoplasia was it was 59%. Now, in terms of the prognosis does best conflicting evidence that study where they where they look that an isolated posterior fossa and large been found that 58% of the patients had abnormal new on development. Now, in terms off, what features that I want you guys to remember is hyperplasia or a genesis off the firmness. Cystic enlargement off the fourth ventricle with an upward spacing off the tentorium on in large posterior fossa and altered anatomy off the content you do not have to remember this, but you remember that doesn't last for Syria. For sir, I don't have a picture off like a normal and at me. But this is relatively a large posterior fossa. Now, the second image eso This is different to this, and this is different than this. But I want you guys just to try and make this one for the soon just first. Just trying not. This was the most striking feature, obviously about from the hydrocephalus here. All these are severe. Done for these. I just saw this. Patricia. Yeah, that was good. It was working. This one. There's a sellable There's a salad bar, a so self cerebella having issue here. That's terrible. The herniation here. And how about peace? Remember, guys, this that's an insult. Follow seem. And here I would say this is the instruction future here now, So this is a kind of a malformation, and it has four types. The two types of associated with hydrocephalus are type two and type one. I'll go back and show you guys which stop is which. But just quickly type one is just down with the displacement off the cerebella tonsils. Type two is down with displacement off the middle of 400 pills on cerebellar. And to this up, it's fine. Talks three. It tends to be aware, uh, rare one. But it's a combination off this raphism, which showed you 30 incidents since the encephalocele s so that there's no image of this with those image off the brainstem protrusion on. But it is a very severe form, and it's it's a seated with hydrocephalus. Tried. Four has cerebella Hypo Leisure on. It's the most of the stuff, most severe, and it's the rarest on. Uh, usually babies do not survive infancy, just going through all the extras again. So that start one cerebella herniation. That's like you. If you look at the tentorial angle, it's a lot higher here. And if you look at the brainstem level slightly below on brain stem on cerebella herniation in the cervical spine. And that's where the DNC fallacy waas that cerebella slash parents temporary a shins. And that's like four terrible heart population. Yeah, s So what is carving Mile formacion? It's a structural defect at the base of the skull on, uh, a study found that patients with me with neurons you defect had up to 86% a form off Kyrie malformation. Now God strong. Think with this is because that shot with you Okay, I'll go back to your question on it and at the end of the talk. But basically forward this image, those one look, it's not slipping off and not schooled. Whole process cephaly, which is a brain math, which is a brain malformation. Basically, the brain fails to divide it into two separate two separate loves. Thean students is around one in in in 10 in 10,000 on the A low before the a lot low bar form, which is no included in this in this image is the most is the most severe on it's the most prevalent this one on. It's usually fatal within the the Dean United Period, and I do encourage you guys to try and look at pictures off these off these different types. But since insurance, um, insurance, simple terms of do the 80 a low, but you basically with half on absolutely interhemispheric fissure, and you have a one of a mono ventricle through throughout on brain with basically look empty. If you get this picture them have similar over which is the one that I've dive showed you. You have an incomplete enter in the hemisphere pressure. You see there's some interference. Fact. Fisher. Hey, that's no damn on. Blow over. This tends to be more more subtle on I. I can't really differentiate it that much. But if you if you want to remember, remember that it's a fusion off the frontal bones off the lab ventricles. Well, absence of septum losing them or fused forks. What this image again If you forget the fact that there's hydrocephalus here, that's the brain here. It's very smooth. Doesn't have gyrus ALS job right away so size. So this is called license cephaly on by included another image to show you another feature that tends to be very common with this and a healthy differentiate between Type one type two, which is the double cortex syndrome. Where if you guys look closely at the colors, that's great matter. That's white matter, and that's a great math again on. Basically, it's a failure for proper and you're on all migration, and that's why I think you get this piece double cortex Centrum, and that's lost it's definitely type one on. It translates to use to smooth brain and suspicion ated with subcortical band heterotopia or the double contacts double coat syndrome on it's characterized by an absent or incomplete child right on it varies in severity. Uh, usually you babies will die before the age of 10. Or, if they survive, they can to know. Developed past the age of 3 to 5 months, and there were some where do up to three years. But maybe this was associated with type two. I'm sorry for the quality of this image, but there's one not many images for for what I wanted to show you here on. This is the one that has relatively declare ist indication off. I'm looking at because smoke. But there's also piece which and there's it's, like a bit bumpy here, a Z. You can call it no nausea, but I think you would appreciate it. Guys like show you an actual image off the off the brain in a bit. And now I'm just gonna show you a mother one. That's something. This one. But the diagnosis here is different again. You have it. It's a follow seeking here with brain are plus. He did not see the nodule a brain here, but there is some form of nodular a shins here on that's license deathly tired, too. And the second image I showed you was for Walker Warburg syndrome. I think these are very red that we might go through our career without seeing a case of the's. But last several type two. It's known as the as the cobblestone to blast and 70 you would have reduction and normal. So that's a so sensation on you would have the nausea slash public public cortex on why you would have this is because of over. Migration usually goes after the S or beyond the development cortex, and that's why you tend to get the nausea or probably break The's usually happened with her development of muscles of brains, and I see on Woke a War Break syndrome is the most it's most severe subtype off this congenital, most disconjugal muscular dystrophy. That subtype is the strong, like a no Patties walker ball Broke syndrome has another name is called Hard Syndrome, and it stands for hydrocephalus, age area, retinal dysplasia and in cephalic on. That's where I mentioned guys the public brain. You can probably see it in which details head that when we assume a bit you can see that's personal, what you would expect a range and look like. And that's just a more into the connection between the brains. Yeah, and lastly, I just just repeated this Just drive the point to be able to differentiate between loss and 75 1 and loss and stuff like that, too. That's the cobblestone here on here. You would have the subcortical band heterotopia for the double cortex central. It can happen on its on its own. But if it happens in the context of flats and cephaly, it's less and 71 on blast me just quickly. I'm gonna I'm gonna brush over the treatment so you can It's you try and treat the underlying course first on. Do you try and remove the course of the CSF off? If it's a clot, try and pick the clot out. If it's a tumor, try and think that humor out cetera well, if he stressors don't work, you go through. Do you see a septal by version, right? You can have a ventricular shunting. You can put it in the in the in the part. Indian first after person, you doesn't work. You can put it in the in the atrium. If the agent doesn't looking for in the in the fluid space that that somewhere that you can put it in the blood. If this does more on if it doesn't work from the brain, you can put a lumbar shunt, so I'll probably do it. Another event where we go through cases and trying to figure out which shunt is the optimal solution is, um, but that's it for now. Thank you guys. Do you have any questions? Please stop them in a shop. We'll get to your question on it now. Yeah, the I don't actually know how I remember them. Just remember that thought this three hasn't. Hasn't Hasn't since. Haven't answered. Follow. See, 54 is so cerebella hypoplasia on type two with just you would have more stuff going out of the brain, then thought one. I guess it starts that helpful. That's helpful. Yeah. Thank you, guys. Thank you for the teaching session. And And thank you for answering the questions. So I think they're saying there's a question popping up Um Oh. Sorry. I think that's for me. Um, I'll have a quick look at that now and get back to you. Okay. Okay. Okay. To answer that question. Not really sure what's going on in him should step. I I think we are still, but I'm trying to get more teachers for the following it, but I'm Do you keep an eye on our email and social media if anything changes and which should be less, you know, members know on email. Okay, If you guys don't have any more question, then thank you very much for attending, and I hope least you learn something in the store. Okay. Uh huh. She just went for a few more minutes to see if there's any depression coming in. Yeah, Um, so just a reminder. The feedback former be sends out after the talk itself. It was a decent through an email show. If you could just place friend if it back for maybe really helpful for us in organizing future events on for ocean teachers as well. And but doing that, um, should be catching a certificate off attendants to show that you've joined our talk. Thank you. Thank you. brother. Think you're honest? Shake of how? How much more? Um, consign for questions. Um, I was just going to wait until, like, 10 t. But it doesn't seem like there is anyone else wanting to ask any questions. You know, if you want to complain, I'm happy to do that. Thank you. Think if they watch guys again, I hope that you that you learned that is something in this In this talk, the whole point was to try and introduce you the topic off off hydrocephalus in the in the pediatric population. Thank you. Last for, like, this fantastic talk, I think I'm sure a lot of people that blends in law since that's quite been each area outside. Thank you so much, everybody. A great evening. Okay, so we've got another one last talk for this academy coming up. Since I do keep an eye forward. That talk and thank you so much. Thank you, guys, but by okay,