Hydrocephalus: Symptoms, Causes and Treatment

Overview

Hydrocephalus is
a chronic, neurological condition caused by an abnormal accumulation of
cerebrospinal fluid (CSF) surrounding the brain or spinal cord. Proper CSF
pressure in the head ensures normal flow and absorption through the
subarachnoid space. However, excessive build-up of CSF widens the interior
cavities in the brain, called ventricles, and increases the pressure on the
brain. While there is currently no cure for
hydrocephalus, its symptoms can be managed with treatment.

In the U.S, the overall prevalence of hydrocephalus is about 0.5 percent. People ranging from infants to seniors could be affected by it. Congenital hydrocephalus affects about one in every 1000 births, yet the incidence of acquired hydrocephalus in adults are not fully known.

Causes

The causes of hydrocephalus vary greatly
from person to person, depending on whether it’s a congenial or an acquired
one, or it’s a part of aging process.

Congenital
hydrocephalus

It is the hydrocephalus present at
birth. Its common causes include:

  • aqueductal stenosis caused by genetic defects
  • brain malformations
  • encephalocele
  • spina bifida
  • intraventricular hemorrhage
  • diseases such as meningitis, tumors, traumatic head injury, or subarachnoid hemorrhage

Acquired
hydrocephalus

It is the hydrocephalus developing after
birth. Its common causes include:

  • Brain tumors
  • Head injuries
  • Intraventricular hemorrhage, commonly as a complication
    of prematurity
  • Meningitis or other infection of the brain or spinal cord

Normal pressure
hydrocephalus (NPH)

It is an accumulation of CSF causing the ventricles to become enlarged. Sometimes, it has little or no increase in intracranial pressure (ICP). However, the exact causes of CSF in most cases are not understood.

Symptoms

The symptoms of hydrocephalus vary significantly from person to
person. Factors such as age, disease progression, and individual differences in
tolerance to the condition will influence the formation of different symptoms. Here
are some overall symptoms of the condition:

  • In an unborn fetus, the enlarged ventricles, which may be detected by an ultrasound, indicates the possible presence of hydrocephalus.
  • In an infant, a rapid increase in the baby’s head is the most obvious indication of hydrocephalus. Additional symptoms may include vomiting, sleepiness, irritability, downward deviation of the eyes, and seizures.
  • Older children may have symptoms like nausea, vomiting, headaches and vision problems.
  • In young and middle-aged adults, some typical symptoms may include disturbance in gait, thinking processes, and bladder control, chronic headaches, problems with balance, poor coordination, urinary incontinence, lethargy, drowsiness, and changes in personality.
  • In older adults with NPH, the most common symptoms include problems with walking, progressive mental impairment and dementia and impaired bladder control.

Diagnosis

A diagnosis of hydrocephalus is usually
based on:

  • A clinical neurological evaluation

The doctor
begins to diagnose hydrocephalus by answering questions about the patient’s
symptoms and medical history and give him or her a general physical exam.

  • A neurological exam

The doctor may conduct relatively simple
tests to judge the patient’s physical features, including his or her muscle
condition, movement, well-being as well as sensory function.

  • Brain imaging tests

Brain imaging tests can show the picture of enlarged ventricle and identify underlying causes of the condition. Imaging tests may include ultrasonography, CT, MRI, or pressure-monitoring techniques.

Treatment

There are three forms of surgical
treatment currently used to manage hydrocephalus.

  • A shunt insertion

Hydrocephalus is mostly treated by inserting
a medical device called a shunt, in the ventricular system of the brain. The shunt diverts the flow of CSF to another region of the body,
most often the
abdominal cavity, or heart. In these areas, CSF can be
absorbed as part of the normal circulatory process.

  • An endoscopic third
    ventriculostomy

A small group of
people may turn to an alternative surgical treatment called an endoscopic third
ventriculostomy (ETV). This procedure creates a pathway for CSF flow within the
cavities in the brain.

  • Choroid plexus
    cauterization (CPC)

The neurosurgeon uses a device to burn or cauterize choroid plexus tissue. The choroid plexus produces CSF in the ventricles of the brain. This treatment is also only applied to a few people.

Keywords: hydrocephalus.

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