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3.5 Minute

22-07-2024 Team Medicover Neurology

What is Hydrocephalus?

Hydrocephalus is a condition where excess cerebrospinal fluid (CSF) accumulates in the brain's ventricles. Derived from Greek, hydrocephalus means water on the brain, but it refers to the buildup of CSF, a clear fluid surrounding the brain and spinal cord. CSF serves several vital functions:

Acts as a shock absorber for the brain and spinal cord.
Delivers nutrients and removes waste from the brain.
Regulates pressure changes between the cranium and spine.

Excess CSF can create harmful pressure on brain tissues within the skull. This accumulation can result from increased fluid production, decreased absorption, or blocked fluid flow.

Common Occurrence: Hydrocephalus can occur at any age

Age Groups Affected
- Most common in infants and adults over 60
- Affects 1 or 2 out of every 1,000 children

Types of Hydrocephalus

Hydrocephalus can be classified into several types based on its characteristics:

Acquired Hydrocephalus

Appears at birth or later in life
Usually caused by disease or injury

Congenital Hydrocephalus

Caused by events during fetal development or genetic abnormalities
Present at birth

Communicating Hydrocephalus

No blockage to CSF flow within the ventricular system
Caused by insufficient absorption or abnormal increase in CSF production

Non-communicating (Obstructive) Hydrocephalus

The flow of CSF is blocked along one or more passages connecting the ventricles.
Pathways enlarge, increasing pressure within the skull

Normal Pressure Hydrocephalus

A type of communicating hydrocephalus most common in the elderly
Characterised by dilated ventricles and normal pressure in the spinal column

Hydrocephalus Ex-vacuo

Affects adults
Occurs when degenerative diseases like Alzheimer's, stroke, or trauma cause brain damage.

Symptoms of Hydrocephalus

The symptoms of hydrocephalus vary greatly between individuals and across age groups.

Infants and Young Children

Unusually large head size
Rapidly increasing head circumference
Prominent scalp veins
Downward deviation of eyes (sunset sign)
Vomiting
Sleepiness
Seizures
Irritability

Children and Adolescents

Nausea and vomiting
Swelling of the optic disc
Blurred or double vision
Balance and gait abnormalities
Slowing or loss of developmental progress
Changes in personality
Inability to concentrate
Seizures
Poor appetite
Urinary incontinence

Adults

Headache
Nausea and vomiting
Difficulty walking or gait disturbances
Loss of balance or coordination
Lethargy
Bladder incontinence
Impaired vision
Impaired analytical skills
Mild dementia

Causes of Hydrocephalus

The causes of hydrocephalus are poorly understood, but it can be associated with various factors:

Inherited conditions
Developmental disorders (e.g., spina bifida, encephalocele)
Brain tumors
Head injuries
Hemorrhage
Diseases like Meningitis

Testing and Diagnosis of Hydrocephalus

When hydrocephalus is suspected, physicians conduct a thorough clinical evaluation, which includes:

Detailed patient history
Physical examination to assess symptoms

Diagnostic Tests

To confirm the diagnosis, the following tests are typically recommended:

CT Scan
MRI
Lumbar Puncture
Intracranial Pressure Monitoring
Isotope Cisternography

These tests help evaluate the presence and severity of hydrocephalus, guiding further treatment decisions.

Treatment of Hydrocephalus

Hydrocephalus can be treated through various methods, depending on its underlying cause:

Shunt Placement

The most common treatment involves implanting a device called a shunt to divert excess cerebrospinal fluid (CSF) away from the brain. The shunt system consists of a tube, catheter, and valve placed in the ventricular space.

It drains CSF to another body cavity where it can be naturally absorHydrocephalus. The shunt remains in place for the patient's lifetime, maintaining normal intracranial pressure.

Surgical Procedures

Shunt Placement: Diverts CSF away from the brain to relieve pressure.
Additional Procedures: This may include removing the source of CSF obstruction, such as a brain tumor.

Alternative Procedure

Endoscopic Third Ventriculostomy (ETV)
- Involves using an endoscope to create a new pathway for CSF flow within the ventricles.
- Suitable for select cases where shunt placement may not be necessary.

Follow-up Care for Hydrocephalus

After surgery for hydrocephalus, ongoing care and monitoring are essential:

Neurological Assessment

Neurological function will be evaluated post-surgery.
Rehabilitation may be necessary to address persistent neurological issues.

Long-term Medical Monitoring

Hydrocephalus requires lifelong medical monitoring.
Regular follow-up tests such as CT scans, MRIs, and X-rays ensure shunt functionality.

Consult Your Doctor If You Experience

Nausea, vomiting, headache, or double vision
Fever
Abdominal pain
Irritability or drowsiness
Pain, tenderness, redness, or swelling along the shunt tube or incision site
Return of preoperative neurological symptoms

Prognosis

The prognosis for people suffering from hydrocephalus can vary. Some people recover without complications or recurring problems. Others live with hydrocephalus their entire lives. The causes of hydrocephalus influence the prognosis. Early identification and treatment can improve the chances of a successful outcome.

Frequently Asked Questions

Diagnosis involves imaging tests like CT scans or MRIs to visualize the brain ventricles, along with measuring intracranial pressure and assessing symptoms.

Treatment often involves surgical placement of a shunt system to divert excess CSF to another part of the body (like the abdomen) where it can be absorHydrocephalus. Endoscopic third ventriculostomy is another surgical option.

While there is no cure for hydrocephalus, effective management through shunting or other surgical procedures can alleviate symptoms and improve quality of life.

Complications may include shunt malfunctions or infections, developmental delays in children, and problems related to long-term shunt dependency.

In infants, hydrocephalus can lead to rapid head growth, irritability, poor feeding, and developmental delays if not promptly treated. Children may experience learning difficulties and cognitive impairments.

NPH is a form of hydrocephalus typically seen in older adults where excess CSF builds up slowly, leading to symptoms such as gait disturbances, urinary incontinence, and cognitive decline.

Some forms of hydrocephalus, such as those caused by infections or bleeding, may be preventable through timely medical interventions and preventive measures.