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Hydrocephalus

Definition


Disease: Hydrocephalus Hydrocephalus
Category: Neurological diseases
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Disease Definition:

When an obstruction in the brain prevents proper fluid drainage and fluid builds up in the brain, hydrocephalus occurs, which is also known as "water on the brain". Brain damage could result in case the excess fluid compresses the surrounding fragile brain tissue. Hydrocephalus could be fatal when it's left without treatment.

Hydrocephalus could be present at birth, or it could develop later in life. This disorder is present in about 1 out of every 500 children. In case someone has hydrocephalus, the outlook will depend on how soon the condition is diagnosed and whether any underlying disorders are present or not.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Based on the age group and disease progression, the signs and symptoms of hydrocephalus could vary.

Some of the common signs and symptoms of hydrocephalus in infants may be:

 

  • Vomiting
  • An unusually large head
  • Seizures
  • A bulging "soft spot" on the top of the head
  • Irritability
  • Developmental delay
  • A rapid increase in the size of the head
  • Sunsetting of the eyes, which is when the eyes are fixed downward
  • Sleepiness


Some of the common signs and symptoms of hydrocephalus in older children and adults may be:

 

  • Problems with balance, coordination or gait
  • Nausea
  • Urinary incontinence
  • Memory loss
  • Sunsetting of the eyes
  • Headache followed by vomiting
  • Confusion
  • Irritability
  • Blurred or double vision
  • Slowing or regression of development
  • Impaired performance in school or work
  • Sluggishness or lack of energy
  • Changes in personality


Depending on the cause of hydrocephalus which varies by age, this condition could cause different combinations of the signs and symptoms mentioned above. For instance, difficulty walking could be the first sign of a condition known as normal pressure hydrocephalus, which mostly occurs in older people. Usually, urinary incontinence develops in addition to a type of dementia that is marked by slowness of information processing and thinking.

When these signs and symptoms appear, infants and toddlers require emergency medical care:

 

  • Exhibiting an unwillingness to bend or move the neck or head
  • A high-pitched cry
  • Seizures
  • Unexplained and recurrent vomiting
  • Breathing difficulties
  • Problems with feeding or sucking


Parents should call their child's doctor in case he/she experiences some of these signs and symptoms:

 

  • A change in the appearance of the face or eyes
  • A rapid increase in the size of the head
  • A decreased level of interest or engagement in social interactions
  • A bulging "soft spot" on the top of the head.


The signs and symptoms mentioned above don't constitute an emergency, but they shouldn't be ignored.

In case older adults experience urinary incontinence, walking difficulty or impaired thinking, they will need a complete physical and neurological exam.

Causes:

Excess fluid buildup in the brain causes hydrocephalus.

Floating in a bath of cerebrospinal fluid, the brain is the consistency of gelatin. Large and open structures, which are called ventricles and lie deep inside the brain, are also filled with this fluid. The fluid-filled ventricles help keep the brain buoyant and cushioned.

By way of interconnecting channels, cerebrospinal fluid flows through the ventricles. Eventually, the fluid will flow into spaces around the brain, where it will be absorbed into the bloodstream.

To maintain normal pressure inside the skull, the production, flow and absorption of cerebrospinal fluid must be kept in balance. When the flow of cerebrospinal fluid is disrupted, for instance when the body doesn't absorb the fluid properly or when a channel between ventricles becomes narrowed, hydrocephalus occurs.

Normal pressure hydrocephalus, which usually occurs in older adults, is caused by the defective absorption of cerebrospinal fluid. Excess fluid enlarges the ventricles in normal pressure hydrocephalus, but it doesn't increase pressure on the brain. Even though the cause in many cases of normal pressure hydrocephalus is not known, it could be caused by an illness or an injury.

Complications

Complications:

The age at which the condition develops and the course it follows will determine the severity of hydrocephalus. Major brain damage and physical disabilities are possible in case the condition is well advanced at birth. However, it's possible to have a nearly normal life span and intelligence when the less severe cases are properly treated.

Treatments:

In most cases, hydrocephalus is treated with surgery. Some of the options may include:

Shunt placement:
The surgical insertion of a drainage system called a shunt is the most common treatment for hydrocephalus. A shunt is a long flexible tube with a valve, which keeps fluid from the brain flowing in the right direction and the proper rate. Usually, one of the ends of the tubing is placed in one of the brain's ventricles. After that, the tubing is tunneled under the skin to another part of the body where the excess cerebrospinal fluid could be more easily absorbed, such as a chamber in the heart or the abdomen.

Usually, people with hydrocephalus need a shunt system for the rest of their lives. To insert longer tubing to match a child's growth, additional surgeries may be needed. In case the tubing becomes blocked or infected, revisions to the shunt may be needed.

Ventriculostomy:
In case there's an obstruction of flow between ventricles, this surgical procedure could be used. In this procedure, a hole will be made in the bottom of one of the ventricles in order to allow the cerebrospinal fluid to flow toward the base of the brain where the absorption is normal.

CARING FOR THE WHOLE CHILD:
In case a child has hydrocephalus, he/she may be recommended working with specialists, such as pediatric psychologists, educational experts or occupational therapists that could help him/her thrive in everyday life and at school. In order to detect any delays in social, intellectual, emotional or physical development, these specialists will evaluate the child's developmental progress on a regular basis. To help the child reach his/her full potential, effective interventions are available.

Prognosis:

Not Available

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