From the Guidelines
Altered sensorium due to increased intracranial pressure from hydrocephalus is called hydrocephalic encephalopathy. This condition occurs when cerebrospinal fluid accumulates in the brain's ventricles, causing them to enlarge and exert pressure on surrounding brain tissue. Unlike metabolic encephalopathy, which results from toxic substances in the blood affecting brain function, hydrocephalic encephalopathy stems from a mechanical pressure issue. The increased pressure disrupts normal brain function by compressing neural tissue, impairing blood flow, and potentially causing ischemia. Symptoms typically include decreased consciousness, confusion, lethargy, headache, nausea, vomiting, and in severe cases, coma.
Key Points
- Hydrocephalus is the most common complication of CNS coccidioidal infection, with a high incidence of up to 40% 1.
- Treatment focuses on addressing the underlying hydrocephalus, usually through surgical interventions like ventriculoperitoneal shunting or endoscopic third ventriculostomy to divert or create alternative pathways for cerebrospinal fluid flow.
- Prompt recognition and treatment are essential as prolonged increased intracranial pressure can lead to permanent neurological damage.
- Medical therapy and repeated lumbar punctures are recommended as initial management for patients with increased ICP at the time of diagnosis 1.
- Early magnetic resonance imaging (MRI) of the brain and neurosurgical consultation are also recommended for patients with increased ICP 1.
From the Research
Altered Sensorium due to Increased Intracranial Pressure from Hydrocephalus
- The condition where altered sensorium is caused by increased intracranial pressure from hydrocephalus can be referred to as hydrocephalic encephalopathy or increased intracranial pressure (ICP) encephalopathy 2.
- Hydrocephalus is a neurological disorder characterized by the accumulation of cerebrospinal fluid (CSF) within the intracranial space, leading to increased ICP, ventriculomegaly, and potential brain damage 3.
- The increased ICP can cause a range of symptoms, including altered sensorium, headache, nausea, vomiting, and papilledema 4, 5.
- The management of hydrocephalus often involves the use of ventriculoperitoneal shunts to divert excess CSF and reduce ICP 3, 6.
- The adjustment of shunt valve opening pressures and body positions can impact ICP and ICP wave amplitude in patients with hydrocephalus 5.
Diagnosis and Management
- Clinical measurement of ICP is often performed to aid in the diagnosis of hydrocephalus, and analysis of ICP waveforms can provide valuable information on CSF dynamics and pressure-volume compensation 2.
- Overnight monitoring of ICP and constant-rate infusion studies can be used to assess cerebrospinal dynamics variables, such as CSF outflow resistance and compliance of CSF space 2.
- The management of increased ICP and hydrocephalus may involve surgical intervention, including the placement of a ventriculoperitoneal shunt, and medical management to reduce ICP and alleviate symptoms 3, 4.