Hydrocephalus
Hydrocephalus is an abnormal buildup of fluid in the ventricles (cavities) deep within the brain. This excess fluid causes the ventricles to widen, putting pressure on the brain’s tissues.
CSF is in constant circulation within the ventricles of the brain and serves many crucial functions:
1) It acts as a “shock absorber” for the brain and spinal cord.
2) It acts as a vehicle for delivering nutrients to the brain and removing waste from it.
3) It flows between the cranium and spine to regulate changes in pressure.
When CSF builds up around the brain, it can create harmful pressures on the tissues of the brain confined within the skull. The accumulation of CSF occurs due to either an increase in production of the fluid, a decrease in its rate of absorption or from a condition that blocks its normal flow through the ventricular system.
Hydrocephalus can happen at any age, but it occurs more frequently among infants and adults 60 and over.
Types –
The four main types of hydrocephalus are:
• Congenital hydrocephalus. This is when someone is born with hydrocephalus.
• Compensated hydrocephalus. This shows up early in life — sometimes before birth — but doesn’t cause symptoms until later in life.
• Acquired hydrocephalus. This is caused by a tumor, cyst, head injury, or a brain infection.
• Normal pressure hydrocephalus. This usually shows up in older adults and leads to a swelling in the small, open areas of the brain but without any change in pressure.
Symptoms –
The signs and symptoms of hydrocephalus vary somewhat by age of onset.
☆ Infants
Common signs and symptoms of hydrocephalus in infants include:
▪︎ Changes in the head
• An unusually large head
• A rapid increase in the size of the head
• A bulging or tense soft spot (fontanel) on the top of the head
▪︎ Physical signs and symptoms
• Nausea and vomiting
• Sleepiness or sluggishness (lethargy)
• Irritability
• Poor eating
• Seizures
• Eyes fixed downward (sunsetting of the eyes)
• Problems with muscle tone and strength
☆ Toddlers and older children
Among toddlers and older children, signs and symptoms might include:
▪︎ Physical signs and symptoms
• Headache
• Blurred or double vision
• Abnormal eye movements
• Abnormal enlargement of a toddler’s head
• Sleepiness or sluggishness
• Nausea or vomiting
• Unstable balance
• Poor coordination
• Poor appetite
• Loss of bladder control or frequent urination
▪︎ Behavioral and cognitive changes
• Irritability
• Change in personality
• Decline in school performance
• Delays or problems with previously acquired skills, such as walking or talking
☆ Young and middle-aged adults
Common signs and symptoms in this age group include:
• Headache
• Sluggishness
• Loss of coordination or balance
• Loss of bladder control or a frequent urge to urinate
• Vision problems
• Decline in memory, concentration and other thinking skills that may affect job performance
☆ Older adults
Among adults 60 years of age and older, the more common signs and symptoms of hydrocephalus are:
• Loss of bladder control or a frequent urge to urinate
• Memory loss
• Progressive loss of other thinking or reasoning skills
• Difficulty walking, often described as a shuffling gait or the feeling of the feet being stuck
• Poor coordination or balance
Causes –
The three main causes of hydrocephalus are:
• A blockage.
Tumors, cysts, birth defects, and other objects in the brain can block or affect the normal flow of cerebrospinal fluid.
• Poor fluid absorption.
Inflammation, injuries, or infections like bacterial meningitis can keep your brain tissues from taking in cerebrospinal fluid.
• Too much fluid.
In rare cases, your body makes more cerebrospinal fluid than your brain can handle.
Risk Factors –
In many cases, the cause of hydrocephalus is unknown. However, a number of developmental or medical problems can contribute to or trigger hydrocephalus.
▪︎ Newborns
Hydrocephalus present at birth (congenital) or shortly after birth can occur because of any of the following:
• Abnormal development of the central nervous system that can obstruct the flow of cerebrospinal fluid
• Bleeding within the ventricles, a possible complication of premature birth
• Infection in the uterus — such as rubella or syphilis — during pregnancy, which can cause inflammation in fetal brain tissues
▪︎ Other contributing factors
Other factors that can contribute to hydrocephalus among any age group include:
• Lesions or tumors of the brain or spinal cord
• Central nervous system infections, such as bacterial meningitis or mumps
• Bleeding in the brain from a stroke or head injury
• Other traumatic injury to the brain
Complications –
In most cases, hydrocephalus progresses, which means complications, including intellectual, developmental and physical disabilities, can occur if it’s not treated. It can also be life-threatening. Less severe cases, when treated appropriately, might have few, if any, serious complications.
Diagnosis –
Your doctor will start with a physical examination and ask about your symptoms, then recommend tests to look for signs of hydrocephalus. Tests may include:
• Neurological examto check muscle strength, reflexes, coordination, balance, vision, eye movement, hearing, mental functioning, and mood
• Ultrasound, which uses sound waves to create an image inside the body
• Magnetic resonance imaging (MRI), a scan that uses powerful magnets and radio waves to make detailed images of your brain
• Computerized tomography (CT) scan, a series of X-rays taken from different angles that are put together to make a more complete picture of your brain
• Spinal tap, when a doctor inserts a needle into the lower back in order to remove and test some of the fluid
• Intracranial pressure monitoring (ICP), which uses a small monitor inserted into the brain to measure how much swelling is there
• Fundoscopic exam, which looks at the nerve behind the eye to see if swelling is present
Treatment –
One of two surgical treatments can be used to treat hydrocephalus.
▪︎ Shunt
The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate.
One end of the tubing is usually placed in one of the brain’s ventricles. The tubing is then tunneled under the skin to another part of the body — such as the abdomen or a heart chamber — where the excess fluid can be more easily absorbed.People who have hydrocephalus usually need a shunt system for the rest of their lives. They require regular monitoring.
▪︎ Endoscopic third ventriculostomy
Endoscopic third ventriculostomy is a surgical procedure that can be used for some people. The surgeon uses a small video camera see inside the brain. Your surgeon makes a hole in the bottom of one of the ventricles or between the ventricles to enable cerebrospinal fluid to flow out of the brain.
▪︎ Other treatments
Some people with hydrocephalus, particularly children, might need additional treatment, depending on the severity of long-term complications of hydrocephalus.
Children’s care teams might include the following:
• Pediatrician or physiatrist, who oversees the treatment plan and medical care
• Pediatric neurologist, who specializes in the diagnosis and treatment of neurological disorders in children
• Occupational therapist, who specializes in therapy to develop everyday skills
• Developmental therapist, who specializes in therapy to help your child develop age-appropriate behaviors, social skills and interpersonal skills
• Mental health professional, such as a psychologist or psychiatrist
• Social worker, who assists the family with getting needed services and planning for transitions in care
Adults with more-severe complications also might need the services of occupational therapists, social workers, specialists in dementia care or other medical specialists.
The prognosis for hydrocephalus depends on the cause, the extent of symptoms and the timeliness of diagnosis and treatment
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