Hydrocephalus: Symptoms, Causes, Treatment

What are the symptoms of hydrocephalus?

Hydrocephalus is a medical condition in which there is an accumulation of cerebrospinal fluid (CSF) within the brain. This can cause increased pressure within the skull, leading to a range of symptoms. The symptoms of hydrocephalus can vary depending on the severity of the condition and the age of the affected individual. Here are some common symptoms of hydrocephalus:

Infants and children:

• Headaches or vomiting
• Irritability or fussiness
• Sleeping more than usual
• Bulging fontanelles (soft spots on the skull)
• Increased head size or head circumference
• Developmental delays or regression
• Seizures

Adults:

• Headaches or migraines
• Confusion or disorientation
• Difficulty concentrating or memory loss
• Personality changes or mood swings
• Vision problems, such as blurred vision or double vision
• Seizures
• Nausea and vomiting
• Increased sensitivity to light and sound

Common symptoms in both infants and adults:

• Loss of balance or coordination
• Difficulty walking or maintaining balance
• Weakness or numbness in the arms and legs
• Increased pressure in the head, which can be described as a feeling of “water pressure” or “fullness”
• Neck stiffness or pain

In severe cases of hydrocephalus:

• Increased intracranial pressure, which can lead to brain damage or even death if left untreated

It’s important to note that not everyone with hydrocephalus will experience all of these symptoms, and some people may only have mild symptoms. If you or your child is experiencing any of these symptoms, it’s essential to consult with a healthcare professional for proper diagnosis and treatment.

What are the causes of hydrocephalus?

Hydrocephalus is a condition where there is an accumulation of cerebrospinal fluid (CSF) within the brain. The causes of hydrocephalus can be divided into two categories: acquired and congenital.

Congenital causes:

1. Brain malformations: Certain brain malformations, such as Arnold-Chiari malformation, can cause hydrocephalus.
2. Blockage in the CSF pathway: Obstructions in the flow of CSF, such as a blockage in the ventricles or the aqueduct of Sylvius, can lead to hydrocephalus.
3. Infections: Certain infections, such as meningitis or encephalitis, can cause inflammation and scarring that can lead to hydrocephalus.
4. Birth trauma: Trauma during delivery, such as a difficult birth or head injury, can cause hydrocephalus.

Acquired causes:

1. Subarachnoid hemorrhage: Bleeding into the space between the brain and the skull can cause hydrocephalus.
2. Meningitis or encephalitis: Infections that affect the meninges (the protective membranes surrounding the brain) or the brain tissue itself can lead to hydrocephalus.
3. Traumatic brain injury: Head injuries, such as those caused by car accidents or falls, can cause hydrocephalus.
4. Tumors: Brain tumors, such as meningiomas or gliomas, can block the flow of CSF and cause hydrocephalus.
5. Vascular malformations: Abnormalities in blood vessels within the brain, such as arteriovenous malformations (AVMs), can cause hydrocephalus.
6. Intraventricular hemorrhage: Bleeding within the ventricles of the brain can cause hydrocephalus.
7. Cancer: Certain types of cancer, such as lymphoma or leukemia, can spread to the brain and cause hydrocephalus.
8. Infections during pregnancy: Infections such as toxoplasmosis or cytomegalovirus (CMV) during pregnancy can increase the risk of developing hydrocephalus.

Other causes:

1. Obstruction of the arachnoid granulations: These small projections on the surface of the brain help to reabsorb CSF; blockages in these areas can lead to hydrocephalus.
2. Surgical complications: Complications from neurosurgical procedures, such as shunt placement or craniotomy, can lead to hydrocephalus.

It’s essential to note that in some cases, the exact cause of hydrocephalus may not be determined. Early diagnosis and treatment are crucial to manage the symptoms and prevent further complications.

How is the diagnosis of hydrocephalus made?

The diagnosis of hydrocephalus is typically made through a combination of physical examination, medical imaging tests, and other diagnostic procedures. Here are some of the common methods used to diagnose hydrocephalus:

1. Physical Examination: A healthcare provider will perform a physical examination to look for signs of increased intracranial pressure, such as:
   • Headache
   • Nausea and vomiting
   • Vision changes (e.g., blurred vision, double vision)
   • Seizures
   • Changes in mental status (e.g., confusion, disorientation)
2. Imaging Tests:
   • Computed Tomography (CT) Scan: A CT scan uses X-rays and computer technology to produce detailed images of the brain. It can help detect enlarged ventricles, effaced sulci (normal folds on the brain’s surface), and other signs of increased intracranial pressure.
   • Magnetic Resonance Imaging (MRI): MRI uses a strong magnetic field and radio waves to produce detailed images of the brain. It can help detect structural abnormalities, such as tumors, cysts, or scarring that may be causing hydrocephalus.
   • Magnetic Resonance Angiography (MRA): MRA is a type of MRI that uses a magnetic field and radio waves to produce detailed images of blood vessels in the brain.
3. Lumbar Puncture (LP): Also known as a spinal tap, this procedure involves inserting a needle into the lower back to collect cerebrospinal fluid (CSF) samples. The CSF is analyzed for:
   • Pressure: Increased pressure in the CSF can indicate hydrocephalus.
   • Composition: The CSF contains proteins, glucose, and other substances that can help diagnose hydrocephalus.
4. Cerebral Spinal Fluid (CSF) Flow Studies: These tests measure the flow of CSF through the ventricles and into the spinal cord. Abnormalities in CSF flow can indicate blockages or obstructions that cause hydrocephalus.
5. Other Diagnostic Tests: Additional tests may include:
   • Electroencephalography (EEG): Measures electrical activity in the brain to rule out seizures or other neurological disorders.
   • Blood tests: To check for underlying conditions that may be contributing to hydrocephalus, such as infections or autoimmune disorders.

Based on the results of these diagnostic tests, healthcare providers can determine whether someone has hydrocephalus and its underlying cause.

What is the treatment for hydrocephalus?

The treatment for hydrocephalus depends on the underlying cause, severity, and location of the condition. Here are some common treatments for hydrocephalus:

1. Shunting: The most common treatment for hydrocephalus is a shunt system, which involves implanting a small tube (shunt) in the brain to drain excess cerebrospinal fluid (CSF) from the brain to another part of the body, such as the abdomen or heart.
   • Ventriculoperitoneal shunt (VP shunt): A VP shunt drains CSF from the ventricles to the peritoneum (abdominal cavity).
   • Lumbar-peritoneal shunt (LP shunt): An LP shunt drains CSF from the lumbar region of the spine to the peritoneum.
   • Gastric shunt: A gastric shunt drains CSF from the ventricles to the stomach.
2. Endoscopic Third Ventriculostomy (ETV): This minimally invasive procedure involves inserting an endoscope through a small opening in the skull to create a new pathway for CSF to flow from the third ventricle to the subarachnoid space, bypassing any blockages.
3. Cisternostomy: This procedure involves creating a new pathway for CSF to flow from the cisterns (spaces between brain tissue) to the subarachnoid space.
4. Medications: In some cases, medications may be used to manage symptoms of hydrocephalus, such as:
   • Diuretics: To reduce fluid production and relieve symptoms.
   • Anti-seizure medications: To control seizures associated with hydrocephalus.
   • Pain relief medications: To manage headaches and other pain associated with hydrocephalus.
5. Surgical decompression: In some cases, surgery may be necessary to remove tumors, cysts, or other lesions that are causing hydrocephalus.
6. Ventricular catheterization: In rare cases, a catheter may be inserted into the ventricles to drain CSF directly into a bag or container.

It’s essential to work with a healthcare provider to determine the best course of treatment for each individual case of hydrocephalus.

Important notes:

• Hydrocephalus can be a chronic condition, and treatments may need to be adjusted over time as the condition progresses.
• Shunts can malfunction or become infected, requiring replacement or additional procedures.
• ETV and cisternostomy may not be suitable for all individuals with hydrocephalus, especially those with complex or extensive scarring.
• Surgery carries risks, including complications, infections, and bleeding.