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Aetiology

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Communicating hydrocephalus most commonly results from deficient reabsorption of CSF absorption due to thickening of the leptomeninges - pia-mater and arachnoid - and / or damage to the arachnoid granulations. Causes include:

  • post-meningitis:
    • bacterial - pneumococcus more than meningococcus
    • tuberculosis
    • fungal
  • subarachnoid haemorrhage - 80% of cases develop some degree of hydrocephalus
  • trauma
  • neoplastic infiltration in the subarachnoid space
  • dural sinus thrombosis - not generally considered as a major cause of hydrocephalus

Less common mechanisms include:

  • increased CSF viscosity - high protein content
  • excess CSF production - choroid plexus papilloma

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