Hydrocephalus medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Ahsan Hussain, M.D.[2]

## Overview

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## Medical Therapy

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* Hydrocephalus is a medical emergency and requires prompt treatment.
* The mainstay of treatment for hydrocephalus is Mannitol to lower down the ICP.
* The managment of hydrocephalus is given below:[1][2][3][4][5][6][7][8][9]

#### Resuscitation:

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* Hydrocephalus is an emergency condition.
* It needs urgent resuscitation and prompt treatment, which is given below:
* Glasgow coma scale (GCS) monitering.
* Oxygen.
* B.P management.
* End organ perfusion.
* Head elevation.
* Fluid managment: Serum osmolarity should be >280mOsmol/l.

* Preferred regimen (1): Hypertonic saline in bolus 250 mL/kg IV.

* Preferred regimen (2): Furosemide 0.5 to 1.0 mg/kg IV q6-12h.

* Preferred regimen (3): Mannitol 0.5-1g/kg in 20% solution IV q6-12h.

* Alternative regimen (1): Glucocorticoids.

* Alternative regimen (2): Pentobarbital 5-20 mg/kg as a bolus followed by 1-4 mg/kg/hr.

* Alternative regimen (3): Acetaminophen 500 mg PO q6h for 7-14 days.

## References

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1. ↑ Procaccio F, Stocchetti N, Citerio G, Berardino M, Beretta L, Della Corte F, D'Avella D, Brambilla GL, Delfini R, Servadei F, Tomei G (March 2000). "Guidelines for the treatment of adults with severe head trauma (part I). Initial assessment; evaluation and pre-hospital treatment; current criteria for hospital admission; systemic and cerebral monitoring". J Neurosurg Sci. 44 (1): 1–10. PMID 10961490.
2. ↑ Davella D, Brambilla GL, Delfini R, Servadei F, Tomei G, Procaccio F, Stocchetti N, Citerio G, Berardino M, Beretta L, Della Corte F (March 2000). "Guidelines for the treatment of adults with severe head trauma (part III). Criteria for surgical treatment". J Neurosurg Sci. 44 (1): 19–24. PMID 10961492.
3. ↑ Lassen NA (June 1974). "Control of cerebral circulation in health and disease". Circ. Res. 34 (6): 749–60. PMID 4598993.
4. ↑ Murray MJ, Cowen J, DeBlock H, Erstad B, Gray AW, Tescher AN, McGee WT, Prielipp RC, Susla G, Jacobi J, Nasraway SA, Lumb PD (January 2002). "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient". Crit. Care Med. 30 (1): 142–56. PMID 11902255.
5. ↑ Bell BA, Smith MA, Kean DM, McGhee CN, MacDonald HL, Miller JD, Barnett GH, Tocher JL, Douglas RH, Best JJ (January 1987). "Brain water measured by magnetic resonance imaging. Correlation with direct estimation and changes after mannitol and dexamethasone". Lancet. 1 (8524): 66–9. PMID 2879175.
6. ↑ García-Sola R, Pulido P, Capilla P (1991). "The immediate and long-term effects of mannitol and glycerol. A comparative experimental study". Acta Neurochir (Wien). 109 (3–4): 114–21. PMID 1907077.
7. ↑ Node Y, Nakazawa S (1990). "Clinical study of mannitol and glycerol on raised intracranial pressure and on their rebound phenomenon". Adv Neurol. 52: 359–63. PMID 2118716.
8. ↑ Roberts I, Yates D, Sandercock P, Farrell B, Wasserberg J, Lomas G, Cottingham R, Svoboda P, Brayley N, Mazairac G, Laloë V, Muñoz-Sánchez A, Arango M, Hartzenberg B, Khamis H, Yutthakasemsunt S, Komolafe E, Olldashi F, Yadav Y, Murillo-Cabezas F, Shakur H, Edwards P (2004). "Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial". Lancet. 364 (9442): 1321–8. doi:10.1016/S0140-6736(04)17188-2. PMID 15474134.
9. ↑ McIntyre LA, Fergusson DA, Hébert PC, Moher D, Hutchison JS (June 2003). "Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review". JAMA. 289 (22): 2992–9. doi:10.1001/jama.289.22.2992. PMID 12799408.

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