PK $\_rels/PK $\ docProps/PK $\ppt/PK $\ ppt/_rels/PK $\ ppt/charts/PK $\ppt/charts/_rels/PK $\ppt/embeddings/PK $\ ppt/media/PK $\ppt/slideLayouts/PK $\ppt/slideLayouts/_rels/PK $\ppt/slideMasters/PK $\ppt/slideMasters/_rels/PK $\ ppt/slides/PK $\ppt/slides/_rels/PK $\ ppt/theme/PK $\ppt/notesMasters/PK $\ppt/notesMasters/_rels/PK $\ppt/notesSlides/PK $\ppt/notesSlides/_rels/PK $\99[Content_Types].xml PK $\]] _rels/.rels PK $\p!docProps/app.xml 0 0 Microsoft Office PowerPoint On-screen Show (16:9) 0 30 30 0 0 false Fonts Used 2 Theme 1 Slide Titles 30 Arial Calibri Office Theme Slide 1Slide 2Slide 3Slide 4Slide 5Slide 6Slide 7Slide 8Slide 9Slide 10Slide 11Slide 12Slide 13Slide 14Slide 15Slide 16Slide 17Slide 18Slide 19Slide 20Slide 21Slide 22Slide 23Slide 24Slide 25Slide 26Slide 27Slide 28Slide 29Slide 30 PptxGenJS false false false 16.0000 PK $\.PFdocProps/core.xml Hydrocephalus & Spinal Malformations PptxGenJS Presentation Prof. Zahid Mahmood Prof. Zahid Mahmood 1 2026-07-12T04:38:28Z 2026-07-12T04:38:28Z PK $\5ͨppt/_rels/presentation.xml.rels PK $\Oݨ ppt/theme/theme1.xmlPK $\]x[[ppt/presentation.xml PK $\Xppt/presProps.xml PK $\ppt/tableStyles.xml PK $\D >00ppt/viewProps.xml PK $\H7t!ppt/slideLayouts/slideLayout1.xml PK $\ђ77,ppt/slideLayouts/_rels/slideLayout1.xml.rels PK $\kQ Q ppt/slides/slide1.xml بِسْمِ اللَّهِ الرَّحْمَٰنِ الرَّحِيمِIn the name of Allah, the Most Gracious, the Most MercifulPK $\3 ppt/slides/_rels/slide1.xml.rels PK $\.ppt/notesSlides/notesSlide1.xml 1PK $\:A*ppt/notesSlides/_rels/notesSlide1.xml.rels PK $\•rrppt/slides/slide2.xml Hydrocephalus & Spinal MalformationsCongenital Neurosurgical ProblemsProf. Zahid MahmoodMBBS, FCPS — General & Laparoscopic SurgeonPK $\2- ppt/slides/_rels/slide2.xml.rels PK $\ppt/notesSlides/notesSlide2.xml 2PK $\xշ*ppt/notesSlides/_rels/notesSlide2.xml.rels PK $\ppt/slides/slide3.xml Did You Know?The brain floats in cerebrospinal fluid.Too much fluid can enlarge a baby's head.The eyes may point down — 'sunset sign'.The spine can fail to close before birth.Folic acid can prevent these spinal defects.PK $\W/ ppt/slides/_rels/slide3.xml.rels PK $\K |Őppt/notesSlides/notesSlide3.xml 3PK $\9 Y*ppt/notesSlides/_rels/notesSlide3.xml.rels PK $\Cqppt/slides/slide4.xml Learning OutcomesDefine hydrocephalus and its types.Recognise its signs in infants.Outline the treatment of hydrocephalus.Classify the spinal malformations.Explain prevention and early treatment.PK $\` ppt/slides/_rels/slide4.xml.rels PK $\vsppt/notesSlides/notesSlide4.xml 4PK $\J *ppt/notesSlides/_rels/notesSlide4.xml.rels PK $\_ppt/slides/slide5.xml Hydrocephalus — DefinitionExcess cerebrospinal fluid within the brain.It collects inside the ventricles.The ventricles enlarge under pressure.It raises the intracranial pressure.Common in infants and children.PK $\5 ppt/slides/_rels/slide5.xml.rels PK $\W8ppt/notesSlides/notesSlide5.xml 5PK $\Qe*ppt/notesSlides/_rels/notesSlide5.xml.rels PK $\,Pppt/slides/slide6.xml Normal CSF CirculationCSF is made by the choroid plexus.It flows through the ventricles in order.It passes the narrow aqueduct of Sylvius.It reaches the space around the brain.It is absorbed into the venous blood.PK $\ج+ ppt/slides/_rels/slide6.xml.rels PK $\zppt/notesSlides/notesSlide6.xml 6PK $\=|*ppt/notesSlides/_rels/notesSlide6.xml.rels PK $\<ppt/slides/slide7.xml Types of HydrocephalusObstructive — a block within the ventricles.Aqueduct stenosis is a common cause.Communicating — absorption is impaired.Seen after infection or bleeding.Both raise the intracranial pressure.PK $\F ppt/slides/_rels/slide7.xml.rels PK $\)lppt/notesSlides/notesSlide7.xml 7PK $\|g*ppt/notesSlides/_rels/notesSlide7.xml.rels PK $\ppt/slides/slide8.xml Causes of HydrocephalusCongenital aqueduct stenosis.Chiari malformation with spina bifida.After meningitis (post-infective).After brain haemorrhage in premature babies.Brain tumours or cysts.PK $\6 ppt/slides/_rels/slide8.xml.rels PK $\iސppt/notesSlides/notesSlide8.xml 8PK $\pO*ppt/notesSlides/_rels/notesSlide8.xml.rels PK $\ blppt/slides/slide9.xml Features in the InfantThe head grows abnormally fast.The fontanelle is tense and bulging.The skull sutures are separated.The eyes show the 'sunset' sign.Irritability, poor feeding and delay.PK $\>$ ppt/slides/_rels/slide9.xml.rels PK $\qppt/notesSlides/notesSlide9.xml 9PK $\1*ppt/notesSlides/_rels/notesSlide9.xml.rels PK $\4ppt/slides/slide10.xml Features in Older ChildrenHeadache, worse in the morning.Vomiting and drowsiness.Papilloedema on eye examination.Blurred or double vision.Signs of raised intracranial pressure.PK $\Ѳ!ppt/slides/_rels/slide10.xml.rels PK $\O ppt/notesSlides/notesSlide10.xml 10PK $\T+ppt/notesSlides/_rels/notesSlide10.xml.rels PK $\,lppt/slides/slide11.xml InvestigationsChart the head circumference over time.Ultrasound through the open fontanelle.CT or MRI shows the ventricles.They reveal the cause and blockage.MRI is best for fine detail.PK $\;!ppt/slides/_rels/slide11.xml.rels PK $\s6ӑ ppt/notesSlides/notesSlide11.xml 11PK $\O+ppt/notesSlides/_rels/notesSlide11.xml.rels PK $\ۦppt/slides/slide12.xml Management of HydrocephalusTreat the underlying cause when possible.A ventriculoperitoneal shunt drains the fluid.It is the commonest treatment.Endoscopic third ventriculostomy suits obstruction.Shunts may block or become infected.PK $\c!ppt/slides/_rels/slide12.xml.rels PK $\*)@ ppt/notesSlides/notesSlide12.xml 12PK $\Fb+ppt/notesSlides/_rels/notesSlide12.xml.rels PK $\#"ppt/slides/slide13.xml Spinal Dysraphism — DefinitionFailure of the neural tube to close.The vertebral arches fail to fuse.A spectrum of spinal defects results.It occurs early in pregnancy.Folic acid deficiency is a key factor.PK $\x!ppt/slides/_rels/slide13.xml.rels PK $\Ї ppt/notesSlides/notesSlide13.xml 13PK $\yv+ppt/notesSlides/_rels/notesSlide13.xml.rels PK $\BϜڥppt/slides/slide14.xml Spina Bifida OccultaOnly the vertebral arch fails to fuse.The cord and skin are normal.Often found by chance on X-ray.Skin markers — a dimple, hair or lipoma.May later tether the spinal cord.PK $\O!ppt/slides/_rels/slide14.xml.rels PK $\0 ppt/notesSlides/notesSlide14.xml 14PK $\?ݤ+ppt/notesSlides/_rels/notesSlide14.xml.rels PK $\Έ ppt/slides/slide15.xml Meningocele & MyelomeningoceleA visible sac appears over the spine.Meningocele — meninges and fluid only.The cord is normal; prognosis is good.Myelomeningocele — cord and nerves involved.It causes paralysis and is most severe.PK $\*R!ppt/slides/_rels/slide15.xml.rels PK $\Qz ppt/notesSlides/notesSlide15.xml 15PK $\$Q+ppt/notesSlides/_rels/notesSlide15.xml.rels PK $\f+ppt/slides/slide16.xml Associated ProblemsHydrocephalus commonly accompanies myelomeningocele.Neurogenic bladder and bowel occur.Lower limb paralysis and deformities.Loss of sensation and pressure sores.The spinal cord may be tethered.PK $\ !ppt/slides/_rels/slide16.xml.rels PK $\  ppt/notesSlides/notesSlide16.xml 16PK $\ y+ppt/notesSlides/_rels/notesSlide16.xml.rels PK $\ɬppt/slides/slide17.xml Investigation & ManagementRaised maternal AFP suggests the defect.Antenatal ultrasound and MRI confirm it.Give folic acid to prevent it.Close an open defect within days.Shunt hydrocephalus; manage bladder and limbs.PK $\檋!ppt/slides/_rels/slide17.xml.rels PK $\r. ppt/notesSlides/notesSlide17.xml 17PK $\BI+ppt/notesSlides/_rels/notesSlide17.xml.rels PK $\4ppt/slides/slide18.xml Take-Home MessageHydrocephalus is excess CSF with raised pressure.Rising head size and sunset eyes in infants.Treat with a shunt or ventriculostomy.Spinal defects range from occulta to myelomeningocele.Folic acid prevents; early closure treats.PK $\Yh!ppt/slides/_rels/slide18.xml.rels PK $\ ppt/notesSlides/notesSlide18.xml 18PK $\N+ppt/notesSlides/_rels/notesSlide18.xml.rels PK $\6`ppt/slides/slide19.xml AssessmentTen Single-Best-Answer QuestionsPK $\~!ppt/slides/_rels/slide19.xml.rels PK $\0[ ppt/notesSlides/notesSlide19.xml 19PK $\i+ppt/notesSlides/_rels/notesSlide19.xml.rels PK $\A4Qppt/slides/slide20.xml MCQ 1A 3-month-old has a rapidly enlarging head, a tense bulging fontanelle, and eyes that deviate downward. The most likely diagnosis is:A. MicrocephalyB. HydrocephalusC. MeningitisD. CraniosynostosisE. Caput succedaneumKey: BPK $\g_!ppt/slides/_rels/slide20.xml.rels PK $\7 ppt/notesSlides/notesSlide20.xml 20PK $\SB+ppt/notesSlides/_rels/notesSlide20.xml.rels PK $\,Mppt/slides/slide21.xml MCQ 2The commonest congenital cause of obstructive (non-communicating) hydrocephalus is stenosis of the:A. Foramen of MonroB. Aqueduct of SylviusC. Foramen of MagendieD. Fourth ventricleE. Choroid plexusKey: BPK $\z!ppt/slides/_rels/slide21.xml.rels PK $\89| ppt/notesSlides/notesSlide21.xml 21PK $\HΩ+ppt/notesSlides/_rels/notesSlide21.xml.rels PK $\}DFFppt/slides/slide22.xml MCQ 3Cerebrospinal fluid is mainly produced by the:A. Arachnoid granulationsB. Choroid plexusC. Pia materD. Dura materE. Ependyma of the aqueductKey: BPK $\dV!ppt/slides/_rels/slide22.xml.rels PK $\cQc ppt/notesSlides/notesSlide22.xml 22PK $\aeZ+ppt/notesSlides/_rels/notesSlide22.xml.rels PK $\k맅ppt/slides/slide23.xml MCQ 4A child with progressive hydrocephalus needs CSF diversion. The commonest procedure performed is a:A. Lumbar punctureB. Ventriculoperitoneal shuntC. CraniotomyD. Permanent external drainE. Burr hole onlyKey: BPK $\A!ppt/slides/_rels/slide23.xml.rels PK $\] ppt/notesSlides/notesSlide23.xml 23PK $\ ~t+ppt/notesSlides/_rels/notesSlide23.xml.rels PK $\$ Иppt/slides/slide24.xml MCQ 5A child with a ventriculoperitoneal shunt develops fever, headache and vomiting some weeks after surgery. The most likely problem is:A. Normal recoveryB. Shunt infection or blockageC. ConstipationD. MigraineE. Otitis mediaKey: BPK $\Y!ppt/slides/_rels/slide24.xml.rels PK $\`z ppt/notesSlides/notesSlide24.xml 24PK $\8+ppt/notesSlides/_rels/notesSlide24.xml.rels PK $\X)ppt/slides/slide25.xml MCQ 6A child has a tuft of hair and a dimple over the lower spine, with intact skin and normal legs. This suggests:A. MyelomeningoceleB. MeningoceleC. Spina bifida occultaD. EncephaloceleE. Sacral tumourKey: CPK $\̜|g!ppt/slides/_rels/slide25.xml.rels PK $\Y ppt/notesSlides/notesSlide25.xml 25PK $\#+ppt/notesSlides/_rels/notesSlide25.xml.rels PK $\gV#ppt/slides/slide26.xml MCQ 7A newborn has a lumbar sac containing spinal cord and nerve roots, with leg weakness and a leaking surface. This is a:A. Spina bifida occultaB. MeningoceleC. MyelomeningoceleD. LipomaE. Dermoid cystKey: CPK $\5b?!ppt/slides/_rels/slide26.xml.rels PK $\Aʑ ppt/notesSlides/notesSlide26.xml 26PK $\${+ppt/notesSlides/_rels/notesSlide26.xml.rels PK $\~Dhhppt/slides/slide27.xml MCQ 8Which antenatal finding suggests an open neural tube defect?A. Low maternal AFPB. Raised maternal alpha-fetoproteinC. Low amniotic fluidD. High blood sugarE. Raised bilirubinKey: BPK $\PG!ppt/slides/_rels/slide27.xml.rels PK $\W  ppt/notesSlides/notesSlide27.xml 27PK $\e+ppt/notesSlides/_rels/notesSlide27.xml.rels PK $\fv__ppt/slides/slide28.xml MCQ 9To reduce the risk of neural tube defects, a mother should take which supplement before and in early pregnancy?A. IronB. Folic acidC. Vitamin DD. CalciumE. Vitamin CKey: BPK $\ [R]!ppt/slides/_rels/slide28.xml.rels PK $\\ ppt/notesSlides/notesSlide28.xml 28PK $\i+ppt/notesSlides/_rels/notesSlide28.xml.rels PK $\yOOppt/slides/slide29.xml MCQ 10A newborn with a myelomeningocele is most likely to also have:A. HydrocephalusB. Cleft palateC. Congenital heart blockD. CataractE. 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