Makomed's Weblog

Water in the brain: Hydrocephalus

Posted on: August 22, 2009

My nursing book has this diagnosis under the pediatric section, but I’ve encountered two patients with it so far and they are both female >50 years old. I used to always write this in my military SOAP notes during my general exams, but I never really knew what for. So naturally, I became curious.

The first, patient A, I could see the grooves on her head. I knew I had to describe if the head shape was irregular, but this was obscure since patient was a black female with knotty hair and considerable alopecia. Without meaning to sounding offensive, her scalp was already irregular and I had seen many men without hair reflect the same type of topography as this woman.

My most recent patient, patient B, was a white woman with uncontrolled diabetes mellitus. I had initially been called out to her to try to educate her husband of whom she depends on for providing insulin. Every time I saw her (she was a daily visit), she always had her head in her hands and was sitting up in bed. She was also stricken with COPD and on continuous O2 therapy but her lungs today were clear, so I ruled out pulmonary involvement. The husband exhibited signs of dementia, so I began harboring some of the duty of insulin administration while present. Eventually, the DM became controlled although not entirely since I couldn’t trust the spouse and his lackluster memory.

Today, her neurologist had finally confirmed her hydrocephalus via an MRI and she scheduled an appointment one month down the line to talk to a surgeon, perhaps to install a shunt?

UPDATE:  Hydrocephalus not inherited congenitally is Normal Pressure Hydrocephalus. My two lady patients mentioned above have developed dementia due to the gradual increase of intracranial pressure to the brain. Most of the time the cause is unknown. A shunt may reverse the symptoms, but is not a cure. Add it to the list of lifelong debilitations.

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