The condition hydracephalus occurs when the brain's cerebrospinal fluid (CSF) becomes too high. Normally, CSF flows through the ventricles, which are fluid-filled spaces in the brain and is reabsorbed into the bloodstream. It is a clear, colorless liquid that surrounds and protects the brain and spinal cord. When something interferes with or blocks the normal flow or absorption of CSF, it can build up and cause them to enlarge. Pressure on the brain tissue can damage it.
Among people of any age, hydrocephalus is more prevalent in infants and older adults. The symptoms of hydrocephalus can vary depending on the age, the type of hydrocephalus, and how severe it is. Hydrocephalus can occur at birth (congenital) or later in life (acquired).
There are different types of hydrocephalus depending on the cause and location of the CSF blockage. Some of the common types are:
Communication hydrocephalus: Despite the fact that the CSF flows between the ventricles, it becomes blocked after it leaves them when this condition occurs. Subarachnoid space, where CSF circulates between the brain and the skull, may be infected, bleed, tumorized, or scarred.
Non-communicating hydrocephalus: This occurs when the CSF cannot flow within the ventricles due to malformations, tumors, cysts, or inflammation within the brain.
Normal pressure hydrocephalus: This occurs when there is an excess amount of CSF in the ventricles, but the pressure inside them remains normal. This can be due to aging, head injury, surgery, infection, or unknown reasons.
Hydrocephalus ex-vacuo: This occurs when there is a loss of brain tissue due to stroke, dementia, or trauma. This creates more space in the skull that is filled with CSF.
The symptoms of hydrocephalus vary depending on the age of the person and the type and severity of the condition. Some of the common symptoms are:
A large or rapidly growing head, a bulging or tense fontanelle (the soft spot on top of the head), vomiting, sleepiness, irritability, poor feeding, seizures, and downward eye deviation (sunsetting eyes).
Child symptoms include headaches, nausea, vomiting, blurred or double vision, eye movement problems, sleepiness, poor appetite, balance and coordination problems, behavioral and cognitive changes, and loss of bladder control.
These conditions include headaches, nausea, vomiting, blurred or double vision, eye movement problems, sleepiness, poor appetite, balance and coordination issues, behavioral and cognitive changes, and loss of bladder control in young and middle-aged adults.
It includes memory loss, cognitive decline, difficulty walking (shuffled gait), poor balance and coordination, and urinary incontinence in older adults.
The diagnosis of hydrocephalus involves a physical examination and a medical history review followed by some tests. Some of the tests that may be done are:
CT scan: This is a type of X-ray that produces detailed images of the brain and can show any abnormalities or enlargement of the ventricles.
MRI scan: This is a type of imaging that uses magnetic fields and radio waves to produce detailed images of the brain and can show any abnormalities or enlargement of the ventricles.
Spinal tap (lumbar puncture): This is a procedure that involves inserting a needle into the lower back to draw out some CSF for analysis. This can help detect any infections or measure the CSF pressure.
Isotopic cisternography: This is a procedure that involves injecting a radioactive substance into the lower back during a spinal tap to monitor how well the CSF is absorbed over time.
Intracranial pressure monitoring: This is a procedure that involves inserting a catheter or a small cable into the brain to measure the pressure inside the ventricles.
Hydrocephalus is treated by inserting shunts or by creating new pathways for CSF drainage to restore and maintain normal CSF levels and pressure in the brain. Some of the surgical procedures include:
The shunt is a small device that consists of a tube and a valve, and is implanted into a patient. The tube is inserted into one of the ventricles and the other end is placed in another part of the body, such as the abdomen or the heart, where the excess CSF can be drained and absorbed. A shunt controls the amount and direction of CSF flow and may need to be replaced or adjusted over time.
A third ventriculostomy (ETV) involves cutting a small hole into the brain's third ventricle, a fluid-filled space, to create a new drainage pathway for CSF. ETV bypasses the blockage and reduces the pressure in the ventricles. It is not suitable for everyone and may not work for a long time.
Some of the ways to prevent or reduce the risk of hydrocephalus are:
Getting vaccinated for meningitis, which is an infection that can cause inflammation of the membranes covering the brain and spinal cord.
Wearing helmets to protect the head from injury when riding bicycles, motorcycles, or other vehicles.
Wearing seat belts when driving or riding in a car to prevent head trauma in case of an accident.
Seeking prompt medical attention for any head injury, infection, bleeding, or stroke that may affect the brain or CSF flow.
When left untreated, hydrocephalus can cause permanent brain damage and impair various functions of the body and mind, making it a serious condition that requires timely diagnosis and treatment. It is possible for people with hydrocephalus to live a normal and productive life with proper care and management.
