Clinical Group : F1

SUPERVISOR: Dr. Asim Khan Rehmani

GROUP LEADER : Sara Ghazal
GROUP MEMBERS :
1. Ambreen Aqeel
2. Batool Fatima Niaz
3. Bushra Jawed
4. Durre Shahwar Shahid
5. Fatima Shahid
6. Ghazal Fatima
7. Neha binte Ahmed
8. Ramsha Nazeer Ahmed
9. Rida Zehra
10. Samra Amin
11. Sara Ghazal
12. Ushba Binte Majeed
13. Yousuf Tahir Ali
 DEFINITION: Hydrocephalus is a condition in which there is an abnormal
collection of cerebrospinal fluid in the ventricular system of brain that results in
dilatation of ventricles, compression of brain parenchyma and increase in
intracranial pressure. This can lead to developmental, physical, and intellectual
impairment.
 SYMPTOMS: It causes different symptoms like headache, vomiting, drowsiness,
sleep disturbance, lethargy etc.
 CAUSES:
a) CONGENITAL CAUSES e.g. neural tube defect, genetics and obstruction etc.
b) ACQUIRED CAUSES e.g. tumor, trauma, infections etc.
OBJECTIVES:
 To identify the frequency of different causes and symptoms of hydrocephalus
and their relation to age in pre-operative patients.

RATIONALE (SIGNIFICANCE) OF STUDY:

 This research is conducted to aid in identifying the causes of hydrocephalus
with regards to various presenting symptoms in different age groups. This will
lead to early diagnosis, prompt treatment and avoidance of complications in
these patients.
 No previous research has been conducted related to this topic by the students
of DUHS.
• STUDY DESIGN: Descriptive Cross Sectional Study

• STUDY POPULATION: Diagnosed cases of hydrocephalus of Neurosurgery

department (OPD & WARD) of Civil Hospital Karachi

• DURATION OF STUDY: 25th February 2017- 30th May 2018

• SAMPLE SIZE: 259 calculated through open EPI

• SAMPLING TECHNIQUE: Non-probability purposive

• INCLUSION CRITERIA OF STUDY PARTICIPANTS: All diagnosed

pre-operative patients of hydrocephalus of all age groups coming to neurosurgery
OPD or admitted in neurosurgery ward of CHK.
• EXCLUSION CRITERIA OF STUDY PARTICIPANTS: Patients of
Normal pressure hydrocephalus and post-operative patients of hydrocephalus
were excluded.

• STUDY TOOL: Structured Questionnaire.

• DATA COLLECTION PLAN. : Informed consent was taken from each

patient fulfilling the inclusion criteria. All the symptoms reported by the patient
were noted down. Diagnosis and their causes were confirmed by radiological
findings of CT or MRI

• STATISTICAL ANALYSIS: Data entry and analysis by SPSS version 17.

Chi-square test was applied and p value of <0.05 was consider significant
 Total patients = 267

Gender :
 Male = 158
 Female = 109

Age :
 Infants = 95
 Children = 84
 Adults = 88
 FREQUENCY OF SYMPTOMS

SYMPTOMS FREQUENCY
Vomiting (56.6%) was the most commonly reported
symptoms by all the patients. AYMPTOMATIC 6.7%

HEADACHE 44.6%

VOMITING 56.6%
IRRITABILITY 37.1%

DROWSINESS 47.2%

ANOREXIA 19.9%

SLEEP
DISTRUBANCE 22.1%
FREQUENCY OF SYMPTOMS IN RELATION TO AGE
 FREQUENCY OF CONGENITAL CAUSES

CONGENITAL FREQUENCY OF
Among congenital causes, neural tube defect CAUSES CONGENITAL CAUSES
was the highest in frequency.
Genetic 7.2%
Neural Tube
defects 45.4%
Obstruction 8.2%

Others 5.2%

Idiopathic 34%
FREQUENCY OF CONGENITAL CAUSES IN
RELATION O AGE
 FREQUENCY OF ACQUIRED CAUSES

ACQUIRED FREQENCY OF
CAUSES ACQUIRED CAUSES

Among acquired causes, tumors (45.3%) were the

most common cause.
Tumor 45.3%

Infection 28.2%

Trauma 11.8%

Obstruction 10.6%

Others 4.1%
FREQUENCY OF ACQUIRED CAUSES IN
RELATION O AGE
The number of male patients in our study was more compared to female patients,
which is consistent with other studies carried out around the globe [3, 4].
 The most common symptoms was vomiting (n=151) followed by drowsiness
(n=126) and headache (n=119).
 With reference to age, vomiting was frequent complain in infants (n=50) and
children (n=58) as consistent with the study conducted at Royal Hospital for Sick
children, Edinburgh [1]. Irritability was the second common symptom in this study,
as opposed to our study due to different age group in which irritability (n=35) in
infants and headache (n=46) in children were commonly reported symptom after
vomiting.
 Headache (n=71) was the commonly reported symptom in adults as consistent
with the study conducted at Civil Hospital karachi[4] and but this study was
restricted to only one cause of hydrocephalus, post tuberculous meningitis while
we included different causes in our study but adults still had headache as most
common symptom.
 In our study, acquired causes (n=170) were found more rather
than congenital causes (n=97) as opposed to the study
conducted at Khyber Pakhtunkhwa [3].
 In congenital, neural tube defect (n=44) was the most
common cause in all subjects as consistent with the study at
Edinburgh but KPK study found aqueductal stenosis as the
most common congenital cause.
 Tumor (n=77) was the most frequent acquired cause in all
subjects as consistent with KPKstudy [3]
 But we relate causes to age in our study which shows
infection (n=8) in infants, and tumor in children (n=27) and
adults (n=47)as the most frequently reported acquired
aetiology.
In this study, it is concluded that the causes
and symptoms of hydrocephalus vary with
age, Therefore, one should consider age
during assessment of patients with
hydrocephalus.
 Our research was limited to patients who were pre-
shunted and only diagnosed hydrocephalus patients
were selected.
 Due to lack of resources and funds selected
patients put into view and diagnosis was made upon
radiological findings.
 Furthermore, research was conducted in Civil
Hospital Karachi only and as the patients usually do
not follow up with the doctor, hence post-operative
patients were not included in the research.
It would be great if further research could be done on:
 Types of tumors causing hydrocephalus.
 Folic acid users VS women who don't use folic acid and the
incidence of hydrocephalous in their babies.
 Common infection causing hydrocephalus and how to
reduce its incidence in our society.
 Which of the treatments of hydrocephalous have the best
outcomes and that too according to the age of the patient
 This research would have not been possible without the help of our
research department who have always helped us with their prompt
replies.
 I would like to express my special thanks of gratitude to Dr. ASIM
KHAN REHMANI, Sir ARIF and Miss BATOOL who have helped us
during our research.
 A bundle of thanks to the patients in the neurosurgery ward who
have always been cooperative with us, always answering to our
questions with patience the research would have not been possible
without their support.
1) für Neurochirurgie klinik, des Saarlandes Universitätsklinikum Homburg/Saar,
Kirrbergerstraße, Homburg/Saar, Deutschland. Regina. Clinical symptoms of
hydrocephalus. Radiologe. 2012 Sep;52(9):807-12. [2]
2) Junaid M, Ahmed M, Rashid MU. An experience with ventriculoperitoneal
shunting at keen’s point for hydrocephalus, Pak J Med Sci. 2018;34(3):691-
695.[3]
3) Mari AR, Shaikh MA, Mallah FA, Ahmed S. Clinical Pattern and Post-Operative
Complications of Post Tuberculous Meningitis Hydrocephalus in Patients
Underwent Ventriculoperitoneal Shunt. Annals of PIMS-Shaheed Zulfiqar Ali
Bhutto Medical University. 2018 Apr 2;14(1):14-8. [4]
4) Kahle KT, Kulkarni AV, Limbrick Jr DD, Warf BC. Hydrocephalus in children. The
lancet. 2016 Feb 20;387(10020):788-99. [5]
5) Rizvi Raza, Anjum Qudsia. Hydrocephalus in children. Journal of Pakistan
Medical Association.2015 November. Kirkpatrick M, Engleman H, Minns RA.
Symptoms and signs of progressive hydrocephalus. Archives of disease in
childhood. 1989 Jan 1;64(1):124-8. [1]
1) Tully HM, Ishak GE, Rue TC, Dempsey JC, Browd SR, Millen KJ, Doherty D, Dobyns WB.
Two hundred thirty-six children with developmental hydrocephalus: causes and
clinical consequences. Journal of child neurology. 2016 Mar;31(3):309-20.
2) Cinalli G, Spennato P, Nastro A, Aliberti F, Trischitta V, Ruggiero C, Mirone G, Cianciulli
E. Hydrocephalus in aqueductal stenosis. Child's Nervous System. 2011 Oct
1;27(10):1621.
3) Tully HM, Dobyns WB. Infantile hydrocephalus: a review of epidemiology, classification
and causes. European journal of medical genetics. 2014 Aug 31;57(8):359-68.
4) Sheehan JP, Polin RS, Sheehan JM, Baskaya MK, Kassell NF. Factors associated
with hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery. 1999
Nov 1;45(5):1120-8.
5) Haridas, Abilash, and Tadanori Tomita "Hydrocephalus in children: Clinical features
and diagnosis."
6) Nagaral, Jayashree, and Vivek Patnam Dinakar. "Anti tubercular drugs,
Hydrocephalus, Morbidity, Tuberculoma, Tuberculous Meningitis." A STUDY ON THE
CLINICAL FEATURES AND COMPLICATIONS OF TUBERCULOUS MENINGITIS IN A TERTIARY
CARE CENTRE OF SOUTHERN INDIA 4954 (2014).
 Tadros FW, Serour H, Zaki SA, Sakr R. The so-called general
symptoms of increased intracranial pressure. Postgrad Med J
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 Rekate, Harold L., and Ari M. Blitz. "Hydrocephalus in
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 FREQUENCY OF CAUSES AND SYMPTOMS OF PRE-OPERATIVE HYDROCEPHALUS
AND THEIR RELATION TO AGE
NAME: ____________________________
GENDER: MALE/ FEMALE_____
AGE: INFANTS (≤ 1YEAR) ____
CHILDREN (>1 YEARS & ≤15 YEARS) ____
ADULTS (>15 YEARS ______

SYMPTOMS
Tick the relevant symptoms YES / NO
• Asymptomatic

• Headache

• Vomiting

• Irritability(behavioural changes)

• Drowsiness or lethargy

• Anorexia

• Sleep disturbance
 CAUSES
CONGENITAL / ACQUIRED______________
Select one if there is congenital cause:
• Neural Tube Defects ____________
• Genetic abnormality (syndromic
features)__________________________
• Obstruction_______________________
• Idiopathic_________________________
• Others____________________________
Select one if there is acquired cause:
Trauma____________________
Infectious__________________
Tumor_____________________
Obstruction________________
Others_____________________