HYDROCEPHALUS

What Is Hydrocephalus?

The medical term “Hydrocephalus” refers to the accumulation of excessive cerebrospinal fluid (CSF) within the cavities or ventricles of the brain. The extra fluid expands the ventricles, putting pressure on the brain. The name “hydrocephalus” comes from the Greek terms “hydro” which means “water” and “Cephalus” which means “head.” Despite the translation as “water on the brain” this term alludes to the accumulation of cerebrospinal fluid (CSF), a clear fluid that bathes the brain and spinal cord and circulates throughout the ventricles. This functions as a shock absorber for the brain and spinal cord and transports nutrients and waste away from the brain. Additionally, CSF regulates pressure fluctuations between the skull and spine.

Hydrocephalus may strike anybody at any age, although it appears more commonly in newborns and those over the age of 60. CSF can cause severe pressure on the brain tissues contained within the skull when it builds up around the brain. However, the pressure associated with excessive CSF can damage brain cells and produce a variety of cognitive deficits. According to the National Institute of Neurological Disorders and Stroke (NINDS), hydrocephalus affects one or two out of every 1,000 infants born in the USA, with possibly higher rates In underdeveloped countries. (Behrens et al., 2014). Doctors discover the majority of cases prior to birth, during delivery, or in early infancy.

What Are The Common Signs And Symptoms Of Hydrocephalus?

The signs and symptoms of hydrocephalus vary greatly from one individual to the next and from one age group to the next. The nonspecific signs and symptoms of elevated intracranial pressure usually accompany acute dilation of the ventricular system. These symptoms may include vomiting, headaches, papilledema, nausea, drowsiness, or coma (Ivkovic et al., 2015). Adults may lose functions like walking and thinking clearly. Common signs of hydrocephalus in different age groups may include:

Infants:

  • Unusually large head
  • Rapid increase of the head’s size
  • Bulging of the fontanelle or soft spot
  • Seizures
  • Sleepiness
  • Poor growth
  • Irritability
  • Vomiting
  • Prominent scalp veins

Children and Adolescents:

  • Headache
  • Lethargy
  • Nausea and vomiting
  • Loss of bladder control
  • Incoordination

Adult:

  • Loss of memory
  • Difficulty walking
  • Impaired vision
  • Dementia
  • Muscle spasm
  • Progressive loss of thinking

What Are The Common Causes Of Hydrocephalus?

An imbalance between the amount of cerebrospinal fluid generated and the amount absorbed into the circulation causes hydrocephalus. Scientists still know very little about the actual cause of the imbalance that results in this condition. Some people develop hydrocephalus at birth, while others develop it in infancy or maturity. Hydrocephalus can occur genetically and link with developmental abnormalities, such as spina bifida or encephalocele (Williams et al., 2007). Sometimes this occurs due to brain tumors, head traumas, bleeding, or illnesses like meningitis. Some conditions of excessive cerebrospinal fluid in the ventricles may include (Deshmukh & Yadav, 2020):

  • Complete or partial obstruction of the CSF
  • Poor absorption of the CSF
  • Overproduction of the CSF

How Do Neuro Specialists Diagnose Hydrocephalus?

Initial diagnosis of hydrocephalus may include an overall clinical evaluation with brief patient history and physical examination of the patient to access the actual condition. Doctors will ask some questions regarding the signs and symptoms of the condition and perform a complete neurological examination of the patient. Some confirmatory tests may include (Abraham et al., 2020):

  • Magnetic resonance imaging (MRI)
  • Computed tomography scan (CT scan)
  • Ultrasound Imaging
  • Lumbar puncture (spinal tap)
  • Intracranial pressure monitoring
  • Isotope cisternography

These tests help to diagnose the actual cause and severity of the condition of patients. After the confirmation of hydrocephalus, the neurosurgeon will evaluate potential treatment options for this condition.

How Do Neuro Specialists Treat Hydrocephalus?

Neurosurgeons can treat hydrocephalus in a variety of ways. Depending on the underlying cause, neurosurgeons can treat Hydrocephalus directly by removing the source of CSF blockage or indirectly by redirecting the extra fluid from the brain. Neurosurgeons most frequently approach hydrocephalus by using a device called “shunt” that diverts excess CSF away from the brain. It comprises a long, flexible tube with a valve that maintains brain fluid flowing in the direction and at the right pace. Surgeons place one end of the tube into one ventricle and then the tube travels under the skins to another part of the body such as the abdomen, where the body reabsorbs the fluid.

Another surgical option includes endoscopic third ventriculostomy. In this procedure, neurosurgeons use a video camera to have a direct view of the brain throughout surgery. To let cerebrospinal fluid drain out of the brain, neurosurgeons create a hole in the bottom of one of the ventricles or between the ventricles. Both of these operations can cause some serious complication such as infection, excessive blood loss, abdominal pain, neurological problems, etc. Sometimes, neurosurgeons inject fibrinolytic agents to degrade the fibrin that cause the obstruction. Neurosurgeons suggest follow-up appointments even after the surgery to avoid any malformation or failure of shunt. For any further questions, please contact us.

References

Abraham, M. E., Povolotskiy, R., Gold, J., Ward, M., Gendreau, J. L., & Mammis, A. (2020). The Current State of Clinical Trials Studying Hydrocephalus: An Analysis of ClinicalTrials.gov. Cureus, 12(8). https://doi.org/10.7759/cureus.10029

Behrens, A., Eklund, A., Elgh, E., Smith, C., Williams, M. A., & Malm, J. (2014). A computerized neuropsychological test battery designed for idiopathic normal pressure hydrocephalus. Fluids and Barriers of the CNS, 11(1). https://doi.org/10.1186/2045-8118-11-22

Deshmukh, S. N., & Yadav, A. T. (2020). Clinical study and management of hydrocephalus in children. International Surgery Journal, 7(4), 1258. https://doi.org/10.18203/2349-2902.isj20201408

Ivkovic, M., Reiss-Zimmermann, M., Katzen, H., Preuss, M., Kovanlikaya, I., Heier, L., … Relkin, N. (2015). MRI assessment of the effects of acetazolamide and external lumbar drainage in idiopathic Normal Pressure Hydrocephalus. Fluids and Barriers of the CNS, 12(1), 1–10. https://doi.org/10.1186/s12987-015-0004-z

Williams, M. A., McAllister, J. P., Walker, M. L., Kranz, D. A., Bergsneider, M., Del Bigio, M. R., … Spinella, G. (2007). Priorities for hydrocephalus research: Report from a National Institutes of Health-sponsored workshop. Journal of Neurosurgery, 107(5 SUPPL.), 345–357. https://doi.org/10.3171/PED-07/11/345