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HYDROCEPHALUS

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HYDROCEPHALUS

Hydrocephalus is a condition characterized by an abnormal accumulation of cerebrospinal fluid within the ventricles of the brain, resulting in increased pressure in the brain.

  • The cerebrospinal fluid (CSF) surrounds the brain and the spinal cord. It plays an important role in the brain functions by acting as a protective cushion to keep the brain from injury, nourishing the brain, and removing waste products of the brain metabolism
  • CSF is produced by specialized cells in the choroid plexuses of the ventricles of the brain. It circulates through the ventricular system in the brain and is absorbed into the bloodstream
  • When the circulatory path of the CSF is blocked, fluid begins to accumulate, causing hydrocephalus
  • Hydrocephalus can occur at any age, but it occurs mostly among infants and adults 60 and above

TYPES AND CAUSES

There are different types of hydrocephalus, they include:

Congenital hydrocephalus – usually present at birth and may be caused by influences or events that occur during fetal development, or genetic abnormalities. This may include an infection in the mother during pregnancy (e.g. rubella, syphilis, toxoplasmosis, or mumps), or a birth defect (e.g. spina bifida)

Acquired hydrocephalus – develops after birth, usually after a stroke, meningitis, brain tumor, or as a result of serious head injury

Normal pressure hydrocephalus (NPH) -a particular form of chronic communicating hydrocephalus that can strike people at any age, but more common in people aged 50 and older. It may result from head trauma, infection, tumor, subarachnoid hemorrhage, or complications from surgery. In some cases, people may develop NPH without any of these factors, usually, for reasons that are not clear, in that case, it is called idiopathic normal pressure hydrocephalus

Communicating hydrocephalus – occurs when the flow of blood is blocked after leaving the ventricles. The various neurologic condition can result in communicating hydrocephalus, including meningitis, subarachnoid hemorrhage

Non-communicating hydrocephalus –occurs when the CSF is blocked along one or more of the thin connections between the ventricles. The blockage may be from a tumor. It is also called obstructive hydrocephalus.

SYMPTOMS

The symptoms vary by age of onset.

In infants, symptoms may include:

  • An unusually large head
  • A rapid increase in head size
  • Poor feeding
  • Sleepiness
  • Seizures
  • Vomiting
  • Irritability
  • Poor growth
  • Poor responsiveness to touch
  • Eyes that appear to gaze downward

Among toddlers and older children, symptoms may include:

  • Headache
  • Poor appetite
  • Poor coordination
  • Unstable balance
  • Blurred or double vision
  • Urinary incontinence
  • Excessive sleepiness
  • A decline in school performance
  • Change in personality
  • Delays with previously acquired skills such as walking or talking
  • Cross eye or uncontrolled eye movement
  • Poor temper control
  • Muscle spasm

In older adults, symptoms may include:

  • Memory loss
  • A progressive loss of thinking or reasoning skills
  • Difficulty walking

DIAGNOSIS AND TREATMENT

For congenital hydrocephalus, a routine prenatal ultrasound scan may detect the condition during pregnancy in the developing fetus.

If the ultrasound scan shows any abnormality, further tests will be ordered.

For acquired hydrocephalus, diagnostic techniques usually include examining medical history, carrying out a physical and a neurological exam, and ordering brain imaging tests, such as CT scan, or MRI scan

TREATMENT

Both congenital and acquired hydrocephalus require urgent treatment to reduce the pressure on the brain and reduce the risk of damage to the brainstem. The brainstem regulates functions such as breathing and heartbeat.

The most common treatment option is the surgical implantation of a shunt. A shunt is a drainage system, that is made up of long, flexible tube which diverts the flow of the fluid into another region of the body, most often the abdominal cavity where it can be absorbed.

People with the condition will usually need to have a shunt system in place for the duration of their life. If the shunt is placed in a child, additional surgeries may be required to insert a longer tubing as they grow.

Another treatment option is the endoscopic third ventriculostomy. In this procedure, the surgeon makes a hole in the bottom of one of the ventricles or between the ventricles, creating a pathway for the fluid to flow out of the brain.

Some children with the condition may need an additional care team treatment depending on the severity. The care team may include an occupational therapist, a developmental therapist, a social worker, a mental health provider, and a special education teacher.