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U hố sau thường gây ra tràn dịch não bằng cách cản trở dòng chảy của dịch não tủy qua tâm thất thứ tư. Cuối cùng, điều kiện viêm như viêm màng não có thể ảnh hưởng đến dịch não tủy chảy. Rối loạn viêm u hạt như bệnh lao hay sarcoidosis có thể gây ra bệnh viêm màng não obliterative ngăn chặn dịch não tủy đi ra từ các bồn cơ bản | 120 Pediatric Neurosurgery Table 1. Causes of hydrocephalus Causes Percent Intraventricular hemorrhage 24.1 Myelomeningocele 21.2 Tumor 9.0 Aqueductal stenosis 7.0 Infection 5.2 Head injury 1.5 Other 11.3 Unknown 11.0 Two or more causes 8.7 Modified from Drake JM Kestle JR Milner R et al. Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 1998 43 294. 6 pineal region and upper brainstem and intraventricular hematoma can also obstruct the aqueduct. Posterior fossa tumors commonly cause hydrocephalus by obstructing CSF flow through the fourth ventricles. Finally inflammatory conditions such as meningitis can affect CSF flow. Granulomatous inflammatory disorders such as tuberculosis or sarcoidosis can cause an obliterative meningitis that prevents CSF egress from the basal cisterns around the brainstem and posterior fossa. Bacterial meningitis usually leads to obliteration of the arachnoid villi leading to what is commonly called communicating hydrocephalus. The majority of new shunts inserted during infancy are related to either spina bifida or intraventricular hemorrhage associated with prematurity see Chapter 5 for a description of posthemorrhagic hydrocephalus . Signs and Symptoms The clinical presentation of hydrocephalus depends on the age of the child. Neonates with hydrocephalus develop progressive head enlargement a bulging fontanelle and splitting of the cranial sutures. Often typical symptoms of ICP such as bradycardia lethargy and apnea are absent. This is particularly the case when the hydrocephalus is slowly progressive. Congenital hydrocephalus in the newborn is not very difficult to diagnose and is often discovered on an antenatal basis by ultrasonography. Later in infancy hydrocephalus often presents as increasing head circumference beyond normal centiles with or without a bulging fontanelle and splitting of sutures. In older children symptoms and signs of hydrocephalus are similar to those seen in .
