What is Hydrocephalus?
There’s an accumulation of water in the brain in the condition called, hydrocephalus. This medical condition literally means “water in the brain”. The medical term hydrocephalus is actually Greek in origin: hydro (water) and cephalus/kephalus (head). Hydrocephalus may already be present at birth which is referred to as congenital. However, brain trauma and infection may also lead to hydrocephalus and this type of hydrocephalus is considered to be acquired.
The water that accumulates within the cerebral cavities, commonly known as ventricles, is actually cerebrospinal fluid (CSF). Cerebrospinal fluid is a special type of fluid found only in the brain as well as the spinal cord. Both adults and children may be affected by hydrocephalus. Normal pressure hydrocephalus is common among older people. There may not be enough statistical data to determine the prevalence of hydrocephalus all over the world. However, it was found out that 1 in every 500 children may suffer from the condition.
There are actually two main types of hydrocephalus. The first type is called communicating hydrocephalus in which the flow of CSF is not obstructed but there’s a presence of mal-absorption. On the other hand, the non-communicating or obstructive type of hydrocephalus happens when the narrow conduits leading to the ventricles become obstructed. The CSF plays a crucial role in the brain and blockage would certainly wreak havoc in the brain as well as in other systems. You’ll find out more on the causes, symptoms, pathophysiology as well as the possible treatments of hydrocephalus as you further read this post.
There are several factors which would influence the manifestations of hydrocephalus. Among these are the age of the patient, severity as well as the ability of an individual to tolerate the condition. Infants and adults have different levels of tolerance to the condition. Infants can better tolerate it because their cranial sutures have not yet closed so these can expand whenever there’s an increase in intracranial pressure. Generally, the symptoms of hydrocephalus may vary depending on some factors. However, the commonly noted symptoms include the following:
- Increased head circumference – This is especially true among infants. Among the common findings in infants with hydrocephalus is the gradual increase in the head circumference.
- Sunsetting – This can be defined as the downward deviation of the eyes.
- Double vision/Tunnel vision
- Balance problems
- Lack of coordination
- Trouble with gait
- Stunted growth (in children)
- Memory loss
- Urinary continence
The majority of these symptoms are primary due to the increase in intracranial pressure. Symptoms would resolve once the intracranial pressure is relieved.
The main cause of hydrocephalus has something to do with the cerebrospinal fluid (CSF) which could either be blocked or simply mal-absorbed. The CSF assumes a critical role in maintaining the homeostasis within the brain as well as in the spinal cord. There are three primary functions of the CSF and these include protecting the brain by acting as a cushion, compensating intracranial changes as well as ferrying both essential nutrients to the brain and removing toxic substances away from it. There should be enough production of CSF and this should also be properly absorbed, otherwise hydrocephalus would likely result.
Different types of hydrocephalus also have variable causes. As with communicating hydrocephalus, there’s no presence of obstruction within the ventricles but there could either be overproduction or mal-absorption of CSF. Obstructive or non-communicating hydrocephalus, as the name suggests, is primarily due to the presence of blockage along the narrow passageways that lead to the ventricles. The main reason for the development of obstructive hydrocephalus is the narrowing of the aqueduct of Sylvius which is a very tiny passage between the third and fourth ventricles.
There are other factors that would lead to the development of hydrocephalus. Adults generally develop a type of hydrocephalus called extra-vacuo right after a stroke or a traumatic brain injury. The presence of tumor, infection, head trauma, subarachnoid hemorrhage and status post surgery would also lead to another type of hydrocephalus called normal pressure hydrocephalus. Children may also develop hydrocephalus due to aqueductal stenosis, neural tube defects, tumor and infection like meningitis.
Imaging studies would greatly be beneficial in diagnosing hydrocephalus. MRI, CT-scan and ultrasonography may be prescribed by your physician. However, the type of imaging test to be performed would also depend on the age of the patient as well as the presence of other brain anomalies.
Once the condition has been confirmed through any of the tests aforementioned, medical intervention may be done. Draining excess CSF is the main target of the treatment and this generally involves the use of a shunt which is a special type of plastic tube directly inserted to the ventricles. This shunt facilitates one-way flow of CSF. The excess CSF is then shunted to the different parts of the body, usually to the abdomen or the lungs because these are areas which may effectively absorb the extra CSF.
Third ventriculostomy is also another procedure that may be done to treat hydrocephalus. Nevertheless, not all patients may be allowed to undergo this. During the procedure, a neuroendoscope will be inserted to the surgical site. This would allow proper viewing of the ventricular area. A very tiny surgical tool would then be inserted once the neuroendoscope is already in place. A small hole would be created to facilitate the flow of the CSF which is then bypassed from the obstruction. The excess CSF would be absorbed by the brain surface.
There are some risks involved though in conducting this procedure as this does not guarantee a hundred percent success. Some of the complications that may transpire following the shunt procedure include tube malfunction, obstruction and infections. Once the shunt fails, this has to be repaired and frequently monitored afterwards.
The prognosis of patients with hydrocephalus is variable. There are a number of factors that would likely influence the improvement of the condition. It is critical that the families of patients with hydrocephalus are informed about hydrocephalus for its proper management.
Pictures collection of Hydrocephalus…