Hydrocephalus and its neuro-ophthalmic complications

Abstract

Obstruction of the cerebral spinal fluid (CSF) pathways, accumulation of CSF within the skull, dilation of the cerebral ventricles, and increased intracranial pressure all result in what is known as “hydrocephalus.” This condition has been found to affect the visual pathway and present with multiple neuro-ophthalmic complications (Chou and Digre, Neurosurg Clin N Am 10:587-608, 1999; Clinical ophthalmology. A systematic approach, Oxford, 1999; Persson et al., Childs Nerv Syst 23:1111-1118, 2007). Papilledema, optic atrophy, ocular motility disorder, visual loss, cortical visual impairment (CVI), visual field loss, and dorsal midbrain syndrome are the main neuro-ophthalmic manifestations of hydrocephalus. These complications have been found to occur more frequently in cases with multiple cerebrospinal fluid shunts (Chou and Digre, Neurosurg Clin N Am 10:587-608, 1999). The sudden appearance of any of these complications usually denotes uncontrolled hydrocephalus, and regular ophthalmic checkups for potentially affected children are important for saving their lives and preserving their vision (Tzekov et al., Pediatr Neurosurg 7:317-320, 1991-1992). Hydrocephalus is a chronic neurological disorder involving enlargement of the ventricles. Because of the close relationship of the third ventricle with the optic nerve, optic chiasm, and cavernous sinus, its enlargement will result to various neuro-ophthalmic disorders (Osher et al., Br J Ophthalmol 62:536-542, 1978). In this chapter, we will discuss each of these neuro-ophthalmic complications and will highlight the importance of each during follow-up.