30 yr old male brought to ED with multiple episodes of seizures since last one week, on the day of arrival since morning patient had four episodes of seizures in between regained consciousness, h/o headache present, no history of vomitings and fever, past history of growth retardation since childhood, and weakness of left upper limb since childhood, history of similar seizure episode one year back subsided with local treatment, on arrival to ED, vitals BP 13/90 mm of hg, PR 69/min, RR 19 /min, a febrile, GRBS 129 mg/dl, CNS pat is conscious and oriented obeying commands, left upper limb power 4/5,pupils b/l equal sluggish reacting, other systemic exam normal, CT brain uploaded, discuss abt diagnosis and management



Communicating Hydrocephalus, grossly dilated lateral Ventricles, could be sec. to IVH / Birth ASPHYXIA. Also r/o CNS TB. Recurrent seizures with possibility of cytotoxic cerebral edema, there is role of mannitol, AED for 3yr , VP Shunt,

patient has hydrocephalus-but its not recent onset convulsion.He's known case and the upper limb weakness might also indicate some sort of young stroke.Hydrocephalus might be a result of young stroke or postmeningitic or post SAH earlier. He has growth retardation-as in what?Either ways-he needs detailed evaluation for the cause-and not just VP shunt for hydrocephalus-espcially if he's conscious and alert as you say.So-MRI and basic evaluation of old papers and a workup for young stroke.Mostly-growth retardation,upper limb weakness and convulsion-means MRI should show something.To rush to VP shunt is a dangerous decision in many situations as the shunt has its own compications.

communicating hydrocephalus most commonly due to hemorrhage or meningitis (bac or tubercular). use hypertonic saline or mannitol to reduce cerebral edema... VP shunt should also be put earliest..

look for the cause of hydrocephalus if possible. check the fundus if compromised then it may progress to optic attophy then vp shunting has to be done if no edema in disc then mey not need the vp shunthing, then try to reduce with mannitol and and further u can add acetazolamide and can give citicholine too

and control seizures with good antiepilepric coverage with phenytoin, valproate etc

communicating hydrocephalus with grossly dilated ventricles.Require vp shunt to prevent further deterioration. IV mannitol may give some temporary relief.The main problem is to control seizures which may be difficult to control and may require multiple drugs may be of 2nd generation.Mentral retardation may remain same.Oral drug for reducing the hydrocephalus may be tried.

It's a developmental malformation I cannot see corpus callosum there,, there is agenesis I think It's arrested hydrocephalous No PVL I don't think we are justified in putting a VP shunt Seizures are not a manifestation of hydrocephalous He has had seizures before Probably not on appropriate antiepiletics Give age and weight appropriate antiepileptics He will be fine

and if MRI doesnt show anything-ETV can be considered.But if its hydrocephalus due to some childhood issue-should the patient keep convulsing on and off like this.Isnt that a rather unusual presentation of hydrocephalus solely due to aqueductal stenosis?Opinions please

I don't think that hydrocephalous is causing the seizures here,, It's just the most prominent feature of the CT scan,, not the actual cause of seizures

a very imp point thr Dr Modi. can hydrocephalus cause convulsion as d latter is a cortical problem. 1.a single convulsion can kill a chronic hydrocephalus pt due to herniation. 2.can convulsion be due to hypoperfusion leading to compromised state with a small trigger. 3.its due to pressure.? 4.its due to cortical subcortical changes due to underlying condition.?

communicating hydrocephalus with dilatation of all ventricles, might be some congenital disorder, he requires VP shunt if affordable programmable vp shunt, but point to be noted is Vp shunt is to prevent him from coning, he might require antiepileptics for long time, mental retardation will not improve.

This is a case of communicating hydrocephalus..

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