Hydrocephalus

Last reviewed by Dr.Mary on August 7th, 2018.

What is Hydrocephalus?

This happens when excessive fluid amasses in the brain, mainly due to an obstruction that prevents fluid to drain properly. This unnecessary fluid may apply pressure on surrounding delicate brain matter and may cause damage to the brain. If not treated, hydrocephalus may be fatal.

Often referred to as “water on the brain”, this condition is most of the time existing at birth, while it can also develop later. About one (1) in 500 children is delivered already having this disorder. Prognosis for individuals having hydrocephalus normally depends on how quickly this problem is diagnosed as well as if any underlying problems are existent.

Hydrocephalus Symptoms

The symptoms and signs of hydrocephalus are various due to the age group as well as the disease develops.

Hydrocephalus Symptoms in Infants

Abnormally large head
Bulging “soft spot” on the top of the head
Rapid increase in the head size
Vomiting
Sleepiness
Seizures
Irritability
Eyes that are fixed downward – referred to as “sunsetting” of eyes
Delays in development

Hydrocephalus in Adults

Headache followed with vomiting
Blurred as well as double vision
Nausea
Eyes fixed downward – referred to as “sunsetting” of the eyes
Lack of energy or sluggishness
Problems concerning balance, gain or coordination
Regression or slowing of development
Confusion
Memory loss
Urinary incontinence
Personality changes
Irritability
Impaired performance at work or school

Hydrocephalus causes various combinations of the above listed symptoms and signs, dependent on the causes and that also vary with age. For instance, a problem referred to as “normal pressure” hydrocephalus that mainly affects individuals who are older – typically beginning with problems walking. The problem of urinary incontinence normally develops, together with a kind of dementia noticeable by thinking slowness as well as slowness in processing information.

Toddlers and infants need emergency medical attention for the following symptoms and signs:

Problems with feeding or sucking
Cry that is high-pitched
Recurrent unexplained vomiting
Reluctances to move or bend the head or neck is exhibiting
Seizures
Breathing difficulties

The following symptoms and signs do not create an emergency situation but they merit a call to the child’s physician:

A bulging “soft spot” on the top of the head
Rapid size increase of the head
Change in look of the eyes or face
Diminished level of engagement or interest in interacting socially

Adults who are older need a total neurological as well as physical exam if suffering:

Difficulties walking
Thinking impaired
Urinary incontinence

Hydrocephalus Causes

Basically hydrocephalus is due to a buildup of excess fluid in the brain.

The brain is the coherence of gelatin or jello and floats in cerebrospinal fluid bath. The fluid fills any big structures that are open, referred to as ventricles that exist deep inside the brain. These fluid full ventricles aid in keeping the brain cushioned as well as buoyant.

This cerebrospinal fluid runs thru these ventricles by a system of channels that are interconnecting. This fluid in time flows into these spaces surrounding the brain and then it is absorbed into the body’s blood system.

It is a delicate balance to keep the production, flowing and absorption of this fluid while keeping normal pressure inside the skull. Hydrocephalus begins when this flowing of cerebrospinal fluid is disturbed – for instance when a passage between ventricles narrows – or when the body does not absorb the fluid properly.

Flawed absorption of this fluid causes “normal pressure hydrocephalus” occurring mainly in older individuals. With this condition, extra fluid enlarges the ventricles but will not raise pressure on the brain. This condition is caused by illness or injury but most of the time, the cause is not known.

Infants who are born prematurely have a risk of developing bleeding that is severe within the ventricles of the brain – known as intraventricular hemorrhage – and this can lead to hydrocephalus.

Some problems while pregnant can also increase the infant’s risk for the development of hydrocephalus, and these include:

Uterus infection
Fetal development problems – such as closure of the spinal column that was incomplete
Development or congenital defects which are not obvious at birth can also increase an older child’s risk of hydrocephalus.
Other factors that can increase the risk of hydrocephalus consist of:
Tumors or lesions of the brain or spinal column
Cranial bleeding
Infections of the central nervous system
Head injury that is severe

Hydrocephalus Treatment

The condition of hydrocephalus is customarily managed by surgery. Options consist of:

Shunt placement

The more common treatment for hydrocephalus is the inserting of a system for drainage by surgery and this is referred to as a shunt. This consists of a flexible long tube that has a valve that will keep fluid flowing from the brain in the correct direction as well as at the rate that is correct. An end of this tube is normally located in one of the ventricles of the brain. This tubing is then burrowed underneath the skin to an alternative area of the body where this excess fluid is most easily absorbed – for instance the chamber in the heart or the abdomen.

Those individuals who have hydrocephalus normally will need this shunt system for the remainder of their lives. Because of this, additional surgeries might be required to insert tubing that is longer in order to match the growth of a child. Shunt revisions also can be needed when or if the tubing gets infected or blocked.

Ventriculostomy

This is a surgical process that often is needed when there is an obstruction of the fluid flow between ventricles. During this surgery, the surgeon creates a hole in the bottom or base of one of these ventricles, in order to allow the fluid to flow toward the base or bottom of the brain, where absorption that is normal occurs.