The term hydrocephalus is derived from the Greek words “hydro” meaning water and “cephalus” meaning head.
As the name implies, it is a condition in which the primary characteristic is excessive accumulation of fluid in the brain.
Hydrocephalus was once known as “water on the brain,” the “water” is actually cerebrospinal fluid (CSF), the clear fluid that surrounds the brain and spinal cord.
The excessive accumulation of CSF results in an abnormal widening of spaces in the brain called ventricles. This widening creates potentially harmful pressure on the tissues of the brain.
A recent research by St. Jude Children’s Research Hospital indicates that Loss of essential protein in the choroid plexus epithelium is linked to hydrocephalus.
The report released on June 23, 2016 indicates that mice lacking the protein Alix develop hydrocephalus or ‘water on the brain.’
Alix ensures that epithelial cells of the choroid plexus are oriented correctly with respect to one another to prevent compromise of the epithelial barrier.
According to the National Institute of Neurological Disorders and Stroke, hydrocephalus is the buildup of too much cerebrospinal fluid (CSF) in the brain.
Normally, this fluid cushions the brain. When there is too much, though, it puts harmful pressure on the brain.
Types of hydrocephalus
There are two types, Congenital hydrocephalus and Acquired hydrocephalus.
Congenital hydrocephalus is present at birth. Causes include genetic problems and problems with how the fetus develops.
An unusually large head is the main sign of congenital hydrocephalus.
Acquired hydrocephalus can occur at any age.
Causes can include head injuries, strokes, infections, tumors and bleeding in the brain.
What causes hydrocephalus
Hydrocephalus may result from inherited genetic abnormalities (such as the genetic defect that causes aqueductal stenosis or developmental disorders.
Other possible causes include complications of premature birth such as intraventricular hemorrhage, diseases such as meningitis, tumors, traumatic head injury, or subarachnoid hemorrhage, which block the exit of CSF from the ventricles to the cisterns or eliminate the passageway for CSF into the cisterns.
Hydrocephalus comes about because of an imbalance between how much cerebrospinal fluid is produced and how much is absorbed into the bloodstream.
Cerebrospinal fluid is produced by tissues lining the ventricles of the brain.
It flows through the ventricles by way of interconnecting channels and eventually flows into spaces around the brain and spinal column.
It’s absorbed primarily by blood vessels in tissues near the base of the brain.
Cerebrospinal fluid plays an important role in brain function by:
- Keeping the brain buoyant, allowing the relatively heavy brain to float within the skull
Cushioning the brain to prevent injury - Removing waste products of the brain’s metabolism
- Flowing back and forth between the brain cavity and spinal column to maintain a constant pressure within the brain — compensating for changes in blood pressure in the brain
Excess cerebrospinal fluid in the ventricles occurs for one of the following reasons:
- Obstruction. The most common problem is a partial obstruction of the normal flow of cerebrospinal fluid, either from one ventricle to another or from the ventricles to other spaces around the brain.
- Poor absorption. Less common is a problem with the mechanisms that enable the blood vessels to absorb cerebral spinal fluid. This is often related to inflammation of brain tissues from disease or injury.
- Overproduction. Rarely, the mechanisms for producing cerebrospinal fluid create more than normal and more quickly than it can be absorbed.
Symptoms of hydrocephalus
According to medicinenet.com, symptoms of hydrocephalus vary with age, disease progression, and individual differences in tolerance to the condition.
For example, an infant’s ability to compensate for increased CSF pressure and enlargement of the ventricles differs from an adult’s.
The infant skull can expand to accommodate the buildup of CSF because the sutures (the fibrous joints that connect the bones of the skull) have not yet closed.
Common signs and symptoms of hydrocephalus in infants include:
- A 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
- Vomiting
- Sleepiness
- Irritability
- Poor feeding
- Seizures
- Eyes fixed downward (sunsetting of the eyes)
Among toddlers and older children, signs and symptoms may include:
- Headache
- Blurred or double vision
- Abnormal enlargement of a toddler’s head
- Sleepiness
- Difficulty remaining awake or waking up
- Nausea or vomiting
- Unstable balance
- Poor coordination
- Poor appetite
- Seizures
- Behavioral and cognitive changes
- Irritability
- Change in personality
- Problems with attention
- Decline in school performance
- Delays or problems with previously acquired skills, such as walking or talking.
Common signs and symptoms in young and middle-aged adults include:
- Headache
- Difficulty in remaining awake or waking up
- Loss of coordination or balance
- Loss of bladder control or a frequent urge to urinate
- Impaired vision
- Decline in memory, concentration and other thinking skills that may affect job performance
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
- Slower than normal movements in general
Diagnosis of hydrocephalus
According to WHO hydrocephalus is diagnosed through clinical neurological evaluation and by using cranial imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), or pressure-monitoring techniques.
Treating hydrocephalus
Hydrocephalus is most often treated surgically by:
- Inserting a shunt system.
This system diverts the flow of CSF (Celebrospinal fluid) from the CNS (central nervous system) to another area of the body where it can be absorbed as part of the normal circulatory process.
A shunt is a flexible but sturdy plastic tube.
A shunt system consists of the shunt, a catheter, and a valve. One end of the catheter is placed within a ventricle inside the brain or in the CSF outside the spinal cord.
The other end of the catheter is commonly placed within the abdominal cavity, but may also be placed at other sites in the body such as a chamber of the heart or areas around the lung where the CSF can drain and be absorbed.
A valve located along the catheter maintains one-way flow and regulates the rate of CSF flow.
2. Ventriculostomy
This is also called endoscopic third ventriculostomy, or ETV.
In this procedure, a neuroendoscope — a small camera that uses fiberoptic technology to visualize small and difficult to reach surgical areas — allows a doctor to view the ventricular surface.
Once the scope is guided into position, a small tool makes a tiny hole in the floor of the third ventricle, which allows the CSF to bypass the obstruction and flow toward the site of reabsorption around the surface of the brain.
3. Lumbar puncture:
This procedure may also be called a spinal tap. A small needle is placed into the lower back.
Fluid will be removed from around the spinal cord and sent to the lab for tests. The test is done to check for bleeding around the brain and spinal cord, and for infection.
This procedure may also be done to take pressure off the brain and spinal cord, or to give medicine.
A child may need to be held in place so that he does not move during the procedure.
4. Diuretics:
Your child may be given diuretics to help decrease the swelling in his brain
Managing hydrocephalus
Hydrocephalus can be managed by being well informed and staying vigilant about complications.
With a complex condition like hydrocephalus, it’s sometimes difficult to discern between a routine medical issue and a life threatening symptom.
Connect with the right healthcare professional to ensure excellent care for all of the patients clinical needs.