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POSTERIOR FOSSA TUMOUR CAUSING HYDROCEPHALUS - Coggle Diagram
POSTERIOR FOSSA TUMOUR CAUSING HYDROCEPHALUS
Review of the normal system:
The cerebrospinal fluid (CSF) is produced by the choroid plexus, in lateral cerebral ventricle.
CSF flows to the bilateral foramen of Monroe, to the third ventricle and to the aqueduct of Sylvius.
Then, it reaches the fourth ventricle, near the posterior fossa.
CSF continues to flow into the subarachnoid spaces and reaches the cerebral venous system through the arachnoid villi (Kahle et al., 2016).
Review of disease condition (pathophysiology):
A tumour formed at the posterior fossa, near the fourth cerebral ventricle.
As the cerebrospinal fluid (CSF) is produced by the choroid plexus at the lateral ventricle, it flows normally to the fourth ventricle through the foramen of Monroe and aqueduct of Sylvius.
However, the flow is obstructed at the fourth ventricle due to the presence of tumour at the posterior fossa.
The obstruction leads to the accumulation of the CSF in the fourth ventricle, which eventually causing all the ventricles to dilate (Kahle et al., 2016). This condition is known as hydrocephalus.
Findings from physical
examination:
Vital signs on admission:
Temp: 36.5°C
BP: 115/65 mmHg
HR: 108 bpm
RR: 28/min
SpO2: 99% (room air)
Pain score: 1/10
Others:
BSL: 5.9 mmol/L
GCS: 15/15
Pupil assessment: Both sides reacted to light.
LOC: Patient was alert and conscious, but weak.
Skin integrity: Intact
Abdomen soft and not distended.
Weight: 24.2 kg
Height: 117 cm
Vital signs during interview:
Temp: 36.7°C
BP: 95/76 mmHg
HR: 111 bpm
RR: 22/min
SpO2: 99% (room air)
Pain score: 0/10
Others:
BSL: 6.1 mmol/L
GCS: 15/15
Pupil assessment: Both sides reacted to light.
LOC: Patient was alert, conscious and resting in bed.
Skin integrity: Intact.
Abdomen soft and not distended.
Weight: 24.2 kg
Height: 117 cm
Signs and symptoms:
Headache at back of the head and neck; on and off for 1 week.
Vomiting; 2 to 3 hours after meal; once every alternate day for 2 weeks.
Poor appetite for 1 week.
Drowsiness.
Diagnostic investigations,
laboratory tests and others:
CT scan (12.08.2021):
Defined hypodense lesion in the
posterior fossa (at region of 4th ventricle)
causing dilatation of all ventricles.
MRI scan (13.08.2021):
Solid cystic lesion from 4th ventricle,
2.8cm × 2.9cm × 2.4cm, with
brainstem compression.
BUSE/Creat:
Na: 137 mmol/L
K: 4.2 mmol/L
Cl: 101 mmol/L
Urea: 5.3 mmol/L
Creat: 43 umol/L
Interpretation: Normal findings.
Management plans:
Treatment and outcome
1) Planned for surgical treatment (suboccipital craniotomy, C1 laminectomy and tumour excision) on 20.08.2021 (Friday).
Outcome: Patient was able to go for surgery as planned.
2) Administer IV Dexamethasone 2mg STAT and IV Phenytoin 70mg STAT before entering operation theater.
Outcome: IV Dexamethasone 2mg and IV Phenytoin 70mg were administered to the patient on 20.08.2021 (Friday) before the surgery.
3) Treat the signs and symptoms of hydrocephalus with the administration of Syrup Phenytoin 70mg (BD); to prevent seizure, Syrup Omeprazole 25mg (BD); to reduce the production of acid in the stomach and prevent vomiting.
Outcome: No seizure and vomiting noted during the hospitalizations, before the surgery.
4) Assess Glasgow Coma Scale (GCS) and pupil monitoring for every 4 hours during the hospitalizations, before the surgery.
Outcome: Assessment was done as ordered. No reduced in GCS and abnormal findings of pupil monitoring during the hospitalizations, before the surgery.
5) Encourage oral feeding in small amount but frequent. Outcome: Patient's appetite is improving and able to eat and drink normally