Hydrocephalus

Hydrocephalus is a medical term for “water on the brain”. It refers to an abnormal buildup of cerebrospinal fluid (CSF) in the cavities (ventricles) of the brain. Hydrocephalus leads to increased pressure within the skull and may lead to an enlarged head in small children and serious, even life-threatening, symptoms.

Causes

In the healthy brain, CSF flows continuously into and out of the brain. Hydrocephalus occurs when the normal outflow of CSF is somehow blocked or impeded (not resorbed into the body)  or when the body produces too much CSF. Hydrocephalus can be congenital, that is, arising from a condition present at birth, or it may be acquired through:

  • Infections of the central nervous system
  • Meningitis
  • Brain tumours
  • Head injuries
  • Intracranial haemorrhage

Terminology

Hydrocephalus occurs when the cavities or ventricles of the brain contain excessive amounts of CSF.  In most cases, hydrocephalus occurs when CSF backs up into the subarchnoid space between the brain and skull. Internal hydrocephalus occurs when the foramen or opening of the fourth ventricle becomes blocked.

Communicating or non-obstructive hydrocephalus occurs when CSF fluid cannot be properly resorbed back into the body. This may result in a condition called normal pressure hydrocephalus (NPH).

Non-communicating or obstructive hydrocephalus occurs when the flow of CSF fluid is blocked, usually involving the foramen of Munro, the aqueduct of Sylvius, the fourth ventricle, or the foramina (plural) of Luschka and the foramen of Magendie. Non-communicating hydrocephalus can cause potentially painful increases in intracranial pressure (pressure within the skull).

Symptoms

The symptoms of hydrocephalus vary by age, the cause of fluid buildup, and the extent of damage. In infants born with hydrocephalus, parents may observe such symptoms as:

  • A larger-than-normal head
  • A bulge at the fontanelle (“soft spot”)
  • Seizures
  • Downward-gazing eyes
  • Excessive sleepiness
  • Vomiting

In children beyond infancy, symptoms may include excessive sleepiness, and vomiting  along with:

  • Difficulty feeding
  • Brief but high-pitched cries
  • Crossed eyes or uncontrolled eye movements
  • Headache
  • Extreme irritability
  • Urinary incontinence
  • Gait disturbances
  • Muscle spasms
  • Slow or restricted or uncoordinated movements
  • Slow growth

Older children may have an enlarged head or a portion of their head may appear large or misshapen, if the hydrocephalus is slow growing and started in infancy, otherwise symptoms will start by headache, followed by neurological and visual symptoms.

Treatment

There are several ways to treat hydrocephalus and expert consultation is required to determine the best course for an individual patient. The goal of all treatment in such cases is to prevent brain damage by improving the flow of CSF. This may be done by removing the blockage in a surgical procedure, installing a shunt (flexible tube) to help drain the fluid, or performing an endoscopic third ventriculostomy (ETV) to relieve pressure. When there is an obstacle at the aqueduct of sylvius or between the third and fourth ventricles. Neuro Spinal Hospital clinicians offer expert treatment of hydrocephalus and can advise patients and their families of the most advanced treatment options.

In some cases, hydrocephalus is associated with an infection, which must be resolved prior to any surgical treatment, and may need temporary external drainage of the CSF.

Prognosis

Left untreated, hydrocephalus is a dangerous and potentially fatal medical condition. When hydrocephalus is expertly treated, the physician team can provide a reasonable prognosis based on the extent of damage. In some cases, hydrocephalus may cause intellectual deficits or problems with behavior, vision, or coordination. About a quarter of hydrocephalus patients develop epilepsy. However, many children born with hydrocephalus have a normal life span and are able to live relatively normal lives.

Risk Factors

There is no way to prevent congenital hydrocephalus. To prevent hydorcephalus caused by injury, children should be protected from head injury and taking other appropriate protective steps (such as using car seats).

Conclusion

Hydrocephalus occurs when too much CSF builds up in the brain, which may cause an enlarged head, painful increased intracranial pressure, and brain damage. Left untreated, hydrocephalus is a dangerous condition but effective treatments are available. Hydrocephalus may be congenital (that is, people are born with it) or it may develop as the result of a brain tumour, cerebral bleed, head injury, or infection.