Hydrocephalus
Hydrocephalus Overview
Hydrocephalus is a condition characterized by excessive accumulation of fluid in the brain. The term is derived from the Greek words for water and head. The fluid is actually cerebrospinal fluid (CSF), a clear fluid that surrounds the brain and spinal cord.
Causes are not well understood but the result is an imbalance between the amount of CSF produced by the body and the amount absorbed into the bloodstream. Buildup of excess CSF causes widening of spaces in the brain called ventricles. This can create potentially harmful pressure on the tissues of the brain.
There is no known way to prevent or cure the condition. However, according to the National Hydrocephalus Foundation death rates associated have decreased from 54 percent to five percent in the past 25+ years.
CSF serves many purposes. It acts as a “shock absorber” for the brain and spinal cord. It is a delivery system for nutrients to the brain and removes waste. And it helps regulate changes in pressure within the brain.
Although the condition can affect people of all ages, hydrocephalus is most common in infants and in adults 60 and older. Most cases are diagnosed before birth (through an ultrasound), at the time of delivery or in early childhood.
Symptoms can mimic those of other conditions including Alzheimer’s Disease, Parkinson’s Disease and Creutzfeldt-Jakob Disease. Your WellStar neurologist will use a variety of methods to determine if the symptoms are those of hydrocephalus or another condition.
Prompt and accurate diagnosis is critically important because the condition may worsen over time if it not properly treated. Early diagnosis and treatment improve the chance of a successful, long-term recovery.
Symptoms
Symptoms of hydrocephalus vary according to the patient’s age, disease progression and individual responses.
In an infant, symptoms include the presence of a tense, bulging soft spot on the head, rapid increase in head circumference and an unusually large-sized head. Other symptoms include vomiting, irritability, sleepiness, defects in muscle tone and strength, seizures and a downward slant of the eyes known as “sun setting.”
In toddlers and older children symptoms can include:
- Fever
- Delays in walking or talking
- Problems with previously acquired skills (like walking and talking)
- Balance and coordination problems
- Blurred or double vision
- Changes in personality
- Problems with attention
- Poor appetite
- Difficulty waking up or staying awake
If young children exhibit any of the following symptoms, seek immediate medical care:
- High-pitched cry
- Sucking or feeding problems
- Recurrent vomiting
- Unwilling to move the head or neck
- Breathing problems
- Seizures
In adults look for symptoms including:
- Headache
- Difficulty waking up or staying awake
- Balance and coordination problems
- Bladder control problems
- Impaired vision
- Problems with memory, concentration or thinking skills
Older adults with hydrocephalus may experience symptoms such as:
- Bladder control problems
- Loss of memory and other thinking skills
- Difficulty walking (shuffling gait)
- Slowed movements
Risk Factors
While the causes of hydrocephalus are not well understood, certain conditions and medical problems increase the chance of getting it.
Newborn risk factors include:
- Inherited genetic abnormalities (including spina bifida) that can obstruct the flow of CSF. Genetic counseling may be recommended to discuss the possibility of recurrence in future pregnancies.
- Complications of premature birth.
- Certain infections (rubella, syphilis) in the mother’s uterus during pregnancy that cause inflammation in fetal brain tissue.
Rick factors for all age groups:
- Certain tumors of the brain or spinal cord
- Infections of the central nervous system (including meningitis and mumps)
- Bleeding in the brain from stroke or head injury
- Traumatic brain injury or hemorrhage that block the exit of cerebrospinal fluid
Hydrocephalus Prevention
Although hydrocephalus cannot be prevented, there are steps you can take to reduce the risk.
- Guard against infections by following recommendations for vaccinations and screenings for your age and sex. Prevent and promptly treat infections and other illnesses.
- Prevent head injury by using appropriate safety equipment such as seat belts, child safety seats and bike helmets.
- Ask your Wellstar neurologist or pediatrician about vaccinating yourself and your children against meningitis.
Hydrocephalus Diagnosis
Your doctor will use several methods to diagnose hydrocephalus:
- Answers to detailed questions about any symptoms.
- A general physical examination.
- A neurological exam to assess muscle strength and tone, reflexes and sense of touch, hearing, coordination, balance and mental wellbeing.
Tools and Tests
Brain imaging tests can help your neurologist determine if the brain’s ventricles (spaces in the brain) are enlarged due to an excess of cerebrospinal fluid.
Depending on the age of the patient and other facts your doctor may recommend these tests:
- Ultrasound imaging for infants or during prenatal examinations
- MRI
- CT
- Pressure-monitoring techniques
Hydrocephalus Treatment
A common treatment for hydrocephalus is a shunting system, which diverts the flow of CSF from the central nervous system to another area of the body where the fluid can be absorbed normally.
A shunt is a flexible, yet sturdy plastic tube. The neurosurgeon places a catheter within a ventricle (space) inside the brain and the other end is placed inside the abdominal cavity or elsewhere in the body. A valve is installed along the length of the catheter to ensure that the fluid flows in one direction and to regulate the flow.
While shunts are effective, there are drawbacks such as possible mechanical failure, infection, obstruction and the need for ongoing monitoring. It is important that the shunt system not over-drain or under-drain, but instead, properly regulate the flow of CSF.
Your Wellstar physician will thoroughly explain the procedure and what you can expect.
Other Treatment Options
Another procedure that may be appropriate in some cases is known as third ventriculostomy. The neurosurgeon inserts a small video camera to visualize the ventricular surface. Then a tiny tool is used to make a hole in the third ventricle (there are four). This allows the CSF to bypass the obstruction and flow properly away from the brain.
Some patients with hydrocephalus require multiple surgical treatments. It is important to recognize when a treatment is not working. Your Wellstar team will help you learn what to look for.
Ongoing Care for Hydrocephalus
According to the National Institute of Neurological Disorders and Stroke (NINDS) the prognosis for people with hydrocephalus is difficult to predict. Factors include the specific cause of the disease, the timeliness of the diagnosis and other medical conditions.
Although hydrocephalus presents risks for cognitive and physical development, many children who receive timely treatment, rehabilitation therapies and educational interventions lead normal lives with few limitations. Similarly, many adults who are treated with shunts and other methods experience a good recovery. The key is early diagnosis and treatment.