Hydrocephalus: Symptoms, Causes, Diagnosis and Treatment
Hydrocephalus is a condition characterized by the accumulation of cerebrospinal fluid in the ventricles of the brain, which results in increased pressure in the brain.
Cerebrospinal fluid (CSF) surrounds the brain and 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 brain ventricles. It circulates through the ventricular system in the brain and is absorbed in the bloodstream. When the circulatory path of the CSF is blocked, fluid begins to build up, causing hydrocephalus.
Hydrocephalus can occur at any age, but it occurs mostly among infants and adults aged 60 and above.
Types and Causes of Hydrocephalus
There are different types of hydrocephalus, these 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. For eg. Rubella, syphilis, toxoplasmosis, mumps and spina bifida.
Acquired hydrocephalus- It develops after birth, usually a stroke, meningitis, brain tumor or as result of serious head injury.
Normal Pressure Hydrocephalus (NPH)- A particular form of chronic 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 and subarachnoid hemorrhage.
Communicating hydrocephalus- It occurs when the flowof blood is blocked after leaving the ventricles. The various neurologic conditions can result in communicating hydrocephalus, including meningitis or subarachnoid hemorrhage.
Non-communicating hydrocephalus- It 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 of Hydrocephalus
In infants, symptoms may include-
- An unusually large head.
- A rapid increase in head size.
- Poor feeding.
- Spina bifida.
- Poor growth.
- Poor responsiveness to touch.
- Eyes that appear to gaze downward.
Among toddlers and older children, symptoms may include-
- Poor appetite.
- Poor coordination.
- Unstable balance.
- Blurred or double vision.
- Urinary incontinence.
- Excessive sleepiness.
- A decline in school performance.
- Change in personality.
- Cross eye.
- Poor temper control.
- Delays with previously acquired skills.
- Muscle spasm.
In older adults, symptoms may include-
- Memory loss.
- Loss of thinking.
- Difficulty walking.
Diagnosis for Hydrocephalus
For congenital hydrocephalus, a routine prenatal ultrasound scan may detect the condition during pregnancy in the developing fetus. If the ultrasound scan shows anything abnormal, additional tests will be performed.
For acquired hydrocephalus, diagnostic techniques usually include examining medical history, carrying out a physical and neurological exam and ordering brain imaging tests such as CT scan or MRI scan.
Treatment for Hydrocephalus
Both congenital and acquired hydrocephalus require prompt treatment to reduce pressure on the brain and the risk of brainstem damage. 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, which is made up of a long, flexible tube that diverts the flow of 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.
When to consult a doctor?
You should make an appointment with your doctor if you experience fever or recurrence of the original symptoms of hydrocephalus.
Some children with the condition may need an additional care team treatment depending on the severity. The care team may include-
- Occupational therapist.
- Developmental therapist.
- A social worker.
- Mental health provider.
- A special education teacher.