Hydrocephalus is due to the accumulation of cerebrospinal fluid (CSF) in the cavities deep within the brain.
Hydrocephalus is a condition of the brain where there is a pressure-induced deterioration of brain functions. It does not go away on its own and needs special treatment.
Hydrocephalus is due to the accumulation of cerebrospinal fluid (CSF) in the cavities deep within the brain. These cavities are called ventricles. Excess CSF increases the size of the ventricles, increasing the pressure on the brain, damaging the brain tissues, and causing impairment of brain functions. Hydrocephalus can occur at any age, but it is most commonly seen in infants and adults aged over 60 years. Hydrocephalus can be treated, usually requiring multiple therapies to manage symptoms, restoring normal CSF levels in the brain and minimizing complications.
What are the signs and symptoms of hydrocephalus?
The signs and symptoms of hydrocephalus vary with the age of the patient.
Infants:
- An abnormally large head that rapidly increases in size
- A bulge on the top of the head that is tense and soft
- Vomiting
- Drowsiness
- Irritability
- Poor feeding
- Seizures
- Decreased muscle strength
- Weakness
- Poor response to touch
- Growth retardation
Children:
- Headache
- An abnormally enlarged head
- Eyes fixed downwards
- Blurred or double vision
- Drowsiness
- Lethargy
- Weakness
- Nausea and/or vomiting
- Instability
- Poor coordination
- Loss of appetite
- Seizures
- Urinary incontinence (involuntary leak of urine)
- Changes in mood and personality and irritability
- Inability to concentrate
- Delayed developmental milestones such as walking or talking
Young and middle-aged adults:
- Headache
- Blurred vision
- Lethargy
- Loss of coordination
- Loss of balance
- Urinary incontinence (loss of bladder control)
- Poor memory
- Inability to concentrate
- Decreased thinking skills
Older adults, above 60 years:
- Loss of bladder control or a frequent urge to urinate
- Loss of memory
- Decreased thinking and reasoning skills
- Difficulty walking
- Instability
- Poor coordination
- Balance problems
What causes hydrocephalus?
Hydrocephalus is caused due to an imbalance between the amount of cerebrospinal fluid (CSF) produced and the amount absorbed into the bloodstream. CSF is produced by the inner lining of the ventricles in the brain. CSF flows through the ventricles, from one ventricle to another, and eventually into the spaces around the brain and spinal cord. CSF is required for the proper functioning of the brain.
Excess CSF in hydrocephalus is caused due to the following:
- Obstruction: Partial or complete obstruction of the normal flow of CSF in any part of the CSF pathway.
- Poor absorption: The amount of CSF produced in the ventricles is normal, but the absorption is decreased, causing a buildup of CSF. There is usually a problem with the blood vessels in the brain, reducing their ability to absorb CSF. This usually occurs due to inflammation of the brain tissues or blood vessels due to disease or trauma.
- Overproduction: CSF is produced at a much faster rate than it can be absorbed, leading to the accumulation of CSF.
Risk factors for hydrocephalus:
The exact event causing hydrocephalus is not always known. There are several factors that trigger or increase the risk of hydrocephalus:
Risk factors for congenital hydrocephalus (present at birth or soon after birth):
- Developmentally abnormal central nervous system obstructing CSF flow
- Premature birth increases the risk of bleeding in the ventricles
- Infections during pregnancy such as rubella or syphilis, causing inflammation of the fetal brain in the uterus
Risk factors in other age groups:
- Tumors in the brain or spinal cord
- Infections of the or in the brain or spine
- Stroke causing bleeding within the brain
- Injury to the head/brain
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What are the complications of hydrocephalus?
Complications of hydrocephalus vary in each individual, depend on the severity, and are often unpredictable. In progressive congenital hydrocephalus, there may be significant intellectual, developmental, and physical disabilities. In less severe cases, if diagnosed and treated early, serious complications can be avoided. Adults may have serious intellectual complications and poorer recovery and may be symptomatic even after treatment.
How is hydrocephalus treated?
A combination of more than one treatment may be required to manage hydrocephalus. Treatment options include:
- Shunt: Shunting is the surgical insertion of a drainage system. A long, flexible tube with a valve is used to keep the cerebrospinal fluid (CSF) from the brain flowing in the right direction and at a proper rate. One end of the tube is placed in one of the ventricles in the brain and then to another part of the body such as the heart or abdomen, where the excess CSF can be absorbed. People may need a shunt system for the rest of their lives, and regular follow-up is required.
- Endoscopic third ventriculostomy: This is a surgical procedure in which the surgeon uses a small video camera to directly visualize the insides of the brain. The surgeon makes a hole in one of the ventricles or between the ventricles, causing the CSF to flow out of the brain.
- Other treatments: Some patients with hydrocephalus, especially children, may need additional treatments and rehabilitation, involving various healthcare professionals to manage complications of hydrocephalus:
- Pediatrician and pediatric neurologist to design a long-term treatment plan for children
- Occupational therapist to rehabilitate patients, enabling them to develop everyday skills
- Speech and language therapist and special education teacher to help children develop age-appropriate speech and language skills, education, and behavior
- Psychologist or psychiatrist to help children and adults cope with the condition and manage associated mental health problems.