Sirkulasi LCS

Dihasilkan oleh plexus choroideus > mengalir dari ventrikel lateralis > melewati foramen

Monroe > ventrikel 3 > melalui aquaductus sylvii > v.quartus > masuk ke foramen lateral

(luschka) & medialis (magendie) > spatium liquor cerebrospinalis externum > meninggalkan

sistem ventricular melalui apertura garis tengah dan lateral dari ventrikel 4 dan masuk ruang

subarachnoid sejumlah kecil di reabsorsi di pembuluh darah kecil piamater/dinding ventricular,

sisanya berjalan melalui vili arachnoid kedalam vena

Hidrosefalus adalah kondisi yang dikarakterisasi dengan akumulasi abnormal dari cairan cerebrospinal didalam ventrikel. Rata rata CSF di produksi sebanyak 500 cc sehari.

Klasifikasi

Hidrosefalus dapat diklasifikasikan atas beberapa hal, antara lain :

1. Berdasarkan Anatomi / tempat obstruksi CSS

Hidrosefalus tipe obstruksi / non komunikans Terjadi bila CSS otak terganggu (Gangguan

di dalam atau pada sistem ventrikel yang mengakibatkan penyumbatan aliran CSS dalam sistem

ventrikel otak), yang kebanyakan disebabkan oleh kongenital : stenosis akuaduktus Sylvius

(menyebabkan dilatasi ventrikel lateralis dan ventrikel III. Ventrikel IV biasanya normal

dalam ukuran dan lokasinya). Yang agak jarang ditemukan sebagai penyebab hidrosefalus

adalah sindrom Dandy-Walker, Atresia foramen Monro, malformasi vaskuler atau tumor

bawaan. Radang (Eksudat, infeksi meningeal). Perdarahan/trauma (hematoma subdural). Tumor

dalam sistem ventrikel (tumor intraventrikuler, tumor parasellar, tumor fossa posterior).

Hidrosefalus tipe komunikans

Penebalan dari arachnoid dibasal otak yang menyebebkan blockade dari aliran CSF dari spinal

ke kortikal subarachnoid space.

Perdarahan akibat trauma kelahiran menyebabkan perlekatan lalu menimbulkan blokade

villi arachnoid.

Radang meningeal

Kongenital :

- Perlekatan arachnoid/sisterna karena

gangguan pembentukan.

- Gangguan pembentukan villi arachnoid

- Papilloma plexus choroideus

Pada dewasa dapat timbul “hidrosefalus tekanan normal” akibat dari :

a).Perdarahan subarachnoid, b).meningitis, c).trauma kepala, dan

d).idiopathic.

Dengan trias gejala :

a).gangguan mental (dementia), b).gangguan koordinasi (ataksia),

c).gangguan kencing (inkontinentia urin)

Normal Pressure Hydrocephalus primer etiologinya idiopatik , NPH sekunder yang

disebabkan oleh cedera kepala,cranial surgery,perdarahan subarachnoid, tumor atau kista ,

meningitis dan other brain infections dapat menpredisposisi inflamasi yang mempengarui

CSF pathway .

NPH biasanya dikarakterisasi dari triad gait disturbance (difficulty walking), mild dementia

dan impaired bladder control. Tidak semuanya muncul dalam waktu bersamaan terkadang

hanya 1 atau 2 symptomps yang muncul.

◼◼Gait disturbances range in severity from mild imbalance to the inability to stand or

walk at all. Gait is described as a “magnetic gait,” often wide-based, short-stepped, slow

and shuffling. People with NPH may have trouble picking up their feet, making stairs and

curbs difficult and frequently resulting in falls. They may also have difficulty turning

around, and turn very slowly with multiple little steps. Gait disturbance is often the most

pronounced symptom and the first to become apparent.

◼◼Mild dementia can be described as a loss of interest in daily activities, forgetfulness,

difficulty dealing with routine tasks andshort-term memory loss. The cognitive symptoms

associated with NPH are usually less severe than full-blown dementia, and are often

overlooked for years or accepted as an inevitable consequence of aging. People with NPH

do not usually lose language skills, but they may be less aware of their deficits than those

around them, and may even deny that there are any problems. Not all individuals have an

obvious cognitive impairment. In mildly affected cases, conversational skills may be

preserved and thinking abilities may be relatively unchanged. In some cases, cognitive

changes may only be detectable with formal neuropsychological testing.

◼◼Impairment in bladder control is usually characterized by urinary frequency and

urgency in mild cases, whereas a complete loss of bladder control (urinary incontinence)

can occur in more severe cases. Urinary frequency is the need to urinate more often than

usual, sometimes as often as every one to two hours. Urinary urgency is a strong,

immediate sensation of the need to urinate. This urge is sometimes so strong that it cannot

be held back, resulting in incontinence. In very rare cases, fecal incontinence may occur.

Some people never display signs of bladder problems.

Because the triad of symptoms are often associated with the aging process in general, and a

majority of the NPH population is older than 60 years, people often assume that they must live

with the problems and adapt to the changes occurring within their bodies as they age.

Symptoms of NPH can also resemble those of other conditions affecting the elderly. For

example, the cognitive deficits of NPH can resemble those associated with early Alzheimer’s,

and the gait disturbances of NPH can look similar to those of Parkinson’s. (In some cases,

NPH can occur in combination with these diseases.)