Hydrocephalus is characterized by the accumulation of cerebrospinal fluid in the head. If not drained, this fluid can cause serious and potentially fatal complications.
What is hydrocephalus?
In hydrocephalus, the pooling of cerebrospinal fluid can raise the pressure inside the skull, putting pressure on and damaging the surrounding brain tissue.
In some cases, it can cause overgrowth of the head, convulsions, brain damage, and hydrocephalus, which can be fatal if left untreated.
Other symptoms include headaches, vomiting, blurred vision, cognitive issues, and walking difficulties.
A patient’s prognosis depends mainly on how quickly the condition is diagnosed and treated and whether there are any underlying disorders.
The term “water in the brain” is incorrect because the brain is surrounded by CSF (cerebrospinal fluid), not water.
CSF has several vital functions:
- Protecting the nervous system
- Nourishes the brain
The brain produces about half a liter of cerebrospinal fluid (CSF) every day, and the old CSF is absorbed by the blood vessels. If the process of CSF production and removal is disrupted, CSF can accumulate, causing hydrocephalus.
Types of Hydrocephalus
There are a number of types, including:
Congenital hydrocephalus
About 1 in 500 American babies are born with (water on the brain). It may be caused by a maternal infection during pregnancy, such as rubella or mumps, or a birth defect, such as spina bifida.
It is one of the most common developmental disabilities, more common than Down syndrome or deafness.
Acquired hydrocephalus
This occurs after birth, usually after a stroke, brain tumor, meningitis, or as a result of a serious head injury.
Communicating hydrocephalus
This type occurs when the cerebrospinal fluid (CSF) pathway is blocked after leaving the ventricles. It’s called “communicating” because the CSF can still flow between the brain’s ventricles.
Noncommunicating hydrocephalus
Also called obstructive hydrocephalus, It occurs when the tiny connections between the ventricles become blocked.
Normal pressure hydrocephalus
This only affects people 50 years of age or older. It may develop after a stroke, injury, infection, surgery, or bleeding. However, in many cases, doctors don’t know why it occurs. An estimated 375,000 older adults in America have normal hydrocephalus.
Ex vacuo hydrocephalus (due to vacuum)
This type occurs after a stroke, traumatic brain injury, or degenerative disease. As brain tissue shrinks, the brain’s ventricles become larger.
Symptoms of Hydrocephalus
Symptoms of congenital hydrocephalus (present at birth):
- Breathing difficulties
- Arm and leg muscles may be stiff
- Some developmental milestones, such as sitting or crawling, may be delayed
- The fontanel, the soft spot at the top of the head, may shrunken and bulge outward
- Irritability and/or drowsiness
- Unwillingness to bend or move the neck or head
- Poor nutrition
- The head looks too big
- The scalp is thin and shiny, and there may be visible veins on the scalp
- The pupil may be close to the bottom of the eyelid, sometimes known as a “sunset.”
- There may be a high-pitched cry at birth
- Vomiting
The symptoms of acquired hydrocephalus, which appears after birth, are:
- Bowel incontinence
- drowsiness and lethargy
- Headache
- irritation
- lack of appetite
- nausea
- Personality changes
- Vision issues, such as blurred or double vision
- Urinary incontinence
- vomiting
- Difficulty walking, especially in adults
Symptoms of normal pressure hydrocephalus:
Signs and symptoms may take several months or years to appear.
- Changes in the way you walk: A person may feel as if they are frozen when they take their first step to start walking.
- The normal thought process slows down: The person may respond to questions more slowly than usual, and reactions to situations may be delayed. The individual’s ability to process information slows down.
- Urinary incontinence: This usually occurs after changes in the way you walk.
Risk factors for hydrocephalus
The following factors increase your risk of hydrocephalus:
- Premature birth: Babies born prematurely are more likely to develop bleeding within the ventricles of the brain, which can lead to the disease.
- Problems during pregnancy: Infection in the uterus during pregnancy increases the risk in the fetus.
- Problems with fetal development: Examples include incomplete closure of the spine.
Other conditions that increase the risk include
- Lesions and tumors of the brain or spinal cord
- Nervous system infections
- cerebral hemorrhage
- Severe head injury
Causes of Hydrocephalus
Hydrocephalus occurs when a large amount of fluid builds up in the brain. Specifically, excess cerebrospinal fluid (cerebrospinal fluid) accumulates in the cavities (ventricles) of the brain.
There are more than 100 possible causes of hydrocephalus, but the main group of causes are:
- Produce too much cerebrospinal fluid.
- This is caused by blocking or narrowing one of the ventricles in the brain, which stops or restricts the flow of cerebrospinal fluid so that it can’t leave the brain.
- When cerebrospinal fluid cannot filter into the bloodstream.
Causes of congenital hydrocephalus (present at birth)
- A baby is born with a blockage in the cerebral aqueduct, a long passage in the midbrain that connects two large ventricles. This is the most common cause.
- The choroid plexus secretes too much cerebrospinal fluid.
- Health conditions or congenital abnormalities in a developing child can cause issues with how the brain develops. For example, hydrocephalus is common in children with severe spina bifida (a birth defect of the spinal cord).
Infections during pregnancy – can affect the development of the baby’s brain. Examples include:
- CMV (cytomegalovirus)
- Rubella (German measles)
- Mumps
- Syphilis
- Toxoplasmosis
Causes of acquired hydrocephalus
This condition develops after birth and is usually caused by an injury or disease leading to a ventricle blockage. The causes may be the following:
- Bleeding in the brain.
- Brain lesions – There are many possible causes, including injury, infection, exposure to certain chemicals, or issues with the immune system.
- Brain tumors – benign (non-cancerous) or malignant (cancerous) tumors in the brain.
- Meningitis – inflammation of the membranes surrounding the brain or spinal cord.
- Stroke – A condition in which a blood clot or a ruptured artery or blood vessel interrupts blood flow to an area of the brain.
Causes of Normal Pressure Hydrocephalus
This condition affects people at least 50 years old – in most cases, doctors don’t know what causes it. Sometimes, it may develop after a stroke, infection, or brain injury.
There are two types of theories:
- Cerebrospinal fluid is not properly absorbed into the bloodstream. Because of this, the brain begins to produce less and less new cerebrospinal fluid, leading to a gradual rise in pressure over a long period of time. This rise in pressure may lead to progressive brain damage.
- An underlying condition, such as heart disease, high cholesterol, or diabetes, may lead to the softening of brain tissue, which in turn leads to increased pressure.
Diagnosis of hydrocephalus
Infants and young children:
A routine prenatal ultrasound scan may detect hydrocephalus during pregnancy in the developing fetus.
The baby’s head is measured regularly after birth. Any abnormalities in head size are likely to lead to further diagnostic tests.
If the ultrasound scan shows any abnormality, further tests will be ordered, such as a magnetic resonance imaging (MRI) or computerized tomography (CT) scan, which gives more detailed images of the brain.
Acquired hydrocephalus (occurs after birth) – If a child or adult develops signs and symptoms, the doctor will:
- Examine the patient’s medical history.
- Perform a physical and neurological examination.
- Order an imaging test, such as a CT scan or MRI.
Normal pressure is more difficult to diagnose because its symptoms are more subtle and do not appear suddenly.
Hydrocephalus Treatment in Turkey
In this section, we will discuss treatments for congenital and acquired hydrocephalus and treatments for normal pressure hydrocephalus.
Treatments for congenital and acquired hydrocephalus in Turkey:
Both types require urgent treatment to minimize pressure on the brain. Otherwise, there is a high risk of damage to the brain stem, which regulates functions such as breathing and heartbeat.
A drainage system called a shunt is performed surgically. A catheter (a thin tube with a valve) is placed in the brain to drain excess water from the brain to another part of the body, such as the abdomen, chest cavity, or heart chamber. Usually, this is all that is required, and no further treatment is needed.
Patients usually require a shunt system that is fixed in place for the rest of their lives. If a shunt is placed in a child, additional surgeries may be needed to insert longer tubes as they grow.
Ventriculostomy – The surgeon makes a hole in the lower part of the ventricle so that the excess fluid flows toward the base of the brain. Natural absorption occurs at the base of the brain. This procedure is sometimes performed when the flow of fluid between the ventricles is obstructed.
Normal pressure hydrocephalus treatment in Turkey
Shunts can also be used for normal-pressure hydrocephalus. However, shunts may not be appropriate for some patients. Other procedures can be performed to check suitability:
Lumbar puncture – Some cerebrospinal fluid is removed from the base of the spine. If this improves the patient’s gait or mental abilities, a shunt is likely to help.
Lumbar Infusion Test: A needle is inserted through the skin of the lower back into the spine. After the fluid is injected, CSF pressure measurements are taken. Patients with CSF pressure above a certain threshold usually benefit from a shunt fitting.
Complications of hydrocephalus
The severity depends on several factors, including when and how the condition develops. If the condition develops when the child is born, there is likely to be brain damage and physical disabilities. However, if the conditions are not severe and treatment is appropriate and prompt, the prognosis is much better.
Children with congenital type may have permanent brain damage, which can lead to long-term complications. Examples include:
- Learning difficulties
- Physical coordination issues
- Memory issues
- Speech Problems
- Problems with vision
Preventing hydrocephalus
Pregnancy – Regular prenatal care can significantly reduce the risk of having a premature baby, reducing the baby’s risk.
Infectious diseases – make sure you have all immunizations and attend all recommended check-ups.
Meningitis vaccine—Meningitis is a common cause of hydrocephalus. Vaccination is recommended for some individuals; consult your doctor.
Preventing head injuries
- Wear your seatbelt every time you drive or ride as a passenger.
- Make sure children’s belts are fastened.
- Never drive under the influence of alcohol.
Protective helmets or headgear should always be worn in the following situations:
- Batting in baseball/softball or cricket.
- Playing contact sports.
- Riding on a horse, motorcycle, bicycle, snowmobile, scooter, or all-terrain vehicle (both riders and passengers).
- Skiing, snowboarding or skateboarding.
Senior living areas:
- Grab bars should be installed next to the bathtub, shower, and/or toilet.
- Seniors should maintain physical activity to ensure that low body strength and balance are adequate (minimizing the risk of falls).
- Make sure the lighting in the house is bright enough.
- Use non-slip mats on bathtub and shower floors.
- Remove carpets and other objects that may cause tripping.
- Stairs should ideally have handrails on both sides.
Living areas for children:
- Install window guards.
- Place safety gates at the bottom and top of the stairs if children are small.
Children’s play areas:
The ground surface of a child’s playground should be made of hardwood shavings, sand, or some other shock-absorbing material.
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