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    What Is Hydrocephalus

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    Gregory Joey
    Hydrocephalus is a condition where excess cerebrospinal fluid accumulates in the brain, resulting in increased pressure. It is usually treated by surgically inserting a shunt system to divert fluid from the brain to the abdomen where it can be absorbed. While shunts often effectively treat hydrocephalus, they can also fail or become infected, requiring monitoring and potential revision. The prognosis varies depending on the cause and presence of other conditions, though timely treatment generally leads to a better outlook.

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    What Is Hydrocephalus

    Uploaded by

    Gregory Joey
    98 views5 pages
    Hydrocephalus is a condition where excess cerebrospinal fluid accumulates in the brain, resulting in increased pressure. It is usually treated by surgically inserting a shunt system to divert fluid from the brain to the abdomen where it can be absorbed. While shunts often effectively treat hydrocephalus, they can also fail or become infected, requiring monitoring and potential revision. The prognosis varies depending on the cause and presence of other conditions, though timely treatment generally leads to a better outlook.

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    Hifrosefalus

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    What is Hydrocephalus

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    Hydrocephalus is a condition where excess cerebrospinal fluid accumulates in the brain, resulting in increased pressure. It is usually treated by surgically inserting a shunt system to divert fluid from the brain to the abdomen where it can be absorbed. While shunts often effectively treat hydrocephalus, they can also fail or become infected, requiring monitoring and potential revision. The prognosis varies depending on the cause and presence of other conditions, though timely treatment generally leads to a better outlook.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    98 views5 pages

    What Is Hydrocephalus

    Uploaded by

    Gregory Joey
    Hydrocephalus is a condition where excess cerebrospinal fluid accumulates in the brain, resulting in increased pressure. It is usually treated by surgically inserting a shunt system to divert fluid from the brain to the abdomen where it can be absorbed. While shunts often effectively treat hydrocephalus, they can also fail or become infected, requiring monitoring and potential revision. The prognosis varies depending on the cause and presence of other conditions, though timely treatment generally leads to a better outlook.

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    © All Rights Reserved
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    of 5

    What is hydrocephalus?

    The term hydrocephalus is derived from the Greek words "hydro" meaning
    water and "cephalus" meaning head. As the name implies, it is a condition in
    which the primary characteristic is excessive accumulation of fluid in the brain.
    Although hydrocephalus was once known as "water on the brain," the "water"
    is actually cerebrospinal fluid (CSF) a clear fluid that surrounds the brain
    and spinal cord. The excessive accumulation of CSF results in an abnormal
    widening of spaces in the brain called ventricles. This widening creates
    potentially harmful pressure on the tissues of the brain.

    The ventricular system is made up of four ventricles connected by narrow


    passages.. Normally, CSF flows through the ventricles, exits into cisterns
    (closed spaces that serve as reservoirs) at the base of the brain, bathes the
    surfaces of the brain and spinal cord, and then reabsorbs into the
    bloodstream.

    CSF has three important life-sustaining functions: 1) to keep the brain tissue
    buoyant, acting as a cushion or "shock absorber"; 2) to act as the vehicle for
    delivering nutrients to the brain and removing waste; and 3) to flow between
    the cranium and spine and compensate for changes in intracranial blood
    volume (the amount of blood within the brain).

    The balance between production and absorption of CSF is critically important.


    Because CSF is made continuously, medical conditions that block its normal
    flow or absorption will result in an over-accumulation of CSF. The resulting
    pressure of the fluid against brain tissue is what causes hydrocephalus.

    What are the different types of hydrocephalus?

    Hydrocephalus may be congenital or acquired. Congenital hydrocephalus is


    present at birth and may be caused by either events or influences that occur
    during fetal development, or genetic abnormalities. Acquired hydrocephalus
    develops at the time of birth or at some point afterward. This type of
    hydrocephalus can affect individuals of all ages and may be caused by injury
    or disease.

    Hydrocephalus may also be communicating or non-communicating.


    Communicating hydrocephalus occurs when the flow of CSF is blocked after it
    exits the ventricles. This form is called communicating because the CSF can
    still flow between the ventricles, which remain open. Non-communicating
    hydrocephalus - also called "obstructive" hydrocephalus - occurs when the
    flow of CSF is blocked along one or more of the narrow passages connecting
    the ventricles. One of the most common causes of hydrocephalus is
    "aqueductal stenosis." In this case, hydrocephalus results from a narrowing of
    the aqueduct of Sylvius, a small passage between the third and fourth
    ventricles in the middle of the brain.
    There are two other forms of hydrocephalus which do not fit exactly into the
    categories mentioned above and primarily affect adults: hydrocephalus ex-
    vacuo and normal pressure hydrocephalus.

    Hydrocephalus ex-vacuo occurs when stroke or traumatic injury


    cause damage to the brain. In these cases, brain tissue may actually shrink.
    Normal pressure hydrocephalus can happen to people at any age, but it is
    most common among the elderly. It may result from a subarachnoid
    hemorrhage, head trauma, infection, tumor, or complications of surgery.
    However, many people develop normal pressure hydrocephalus even when
    none of these factors are present for reasons that are unknown.

    Who gets this disorder?

    The number of people who develop hydrocephalus or who are currently living
    with it is difficult to establish since there is no national registry or database of
    people with the condition. However, experts estimate that hydrocephalus
    affects approximately 1 in every 500 children.

    What causes hydrocephalus?

    The causes of hydrocephalus are still not well understood. Hydrocephalus


    may result from inherited genetic abnormalities (such as the genetic defect
    that causes aqueductal stenosis) or developmental disorders (such as those
    associated with neural tube defects including spina bifida and encephalocele).
    Other possible causes include complications of premature birth such as
    intraventricular hemorrhage, diseases such as meningitis, tumors, traumatic
    head injury, or subarachnoid hemorrhage, which block the exit of CSF from the
    ventricles to the cisterns or eliminate the passageway for CSF into the
    cisterns.

    What are the symptoms?

    Symptoms of hydrocephalus vary with age, disease progression, and


    individual differences in tolerance to the condition. For example, an infant's
    ability to compensate for increased CSF pressure and enlargement of the
    ventricles differs from an adult's. The infant skull can expand to accommodate
    the buildup of CSF because the sutures (the fibrous joints that connect the
    bones of the skull) have not yet closed.

    In infancy, the most obvious indication of hydrocephalus is often a rapid


    increase in head circumference or an unusually large head size. Other
    symptoms may include vomiting, sleepiness, irritability, downward deviation of
    the eyes (also called "sunsetting"), and seizures.

    Older children and adults may experience different symptoms because their
    skulls cannot expand to accommodate the buildup of CSF. Symptoms may
    include headache followed by vomiting, nausea, papilledema (swelling of the
    optic disk which is part of the optic nerve), blurred or double vision, sunsetting
    of the eyes, problems with balance, poor coordination, gait disturbance,
    urinary incontinence, slowing or loss of developmental progress, lethargy,
    drowsiness, irritability, or other changes in personality or cognition including
    memory loss.

    Symptoms of normal pressure hydrocephalus include, problems with walking,


    impaired bladder control leading to urinary frequency and/or incontinence, and
    progressive mental impairment and dementia. An individual with this type of
    hydrocephalus may have a general slowing of movements or may complain
    that his or her feet feel "stuck." Because some of these symptoms may also be
    experienced in other disorders such as Alzheimer's disease, Parkinson's
    disease, and Creutzfeldt-Jakob disease, normal pressure hydrocephalus is
    often incorrectly diagnosed and never properly treated. Doctors may use a
    variety of tests, including brain scans (CT and/or MRI), a spinal tap or lumbar
    catheter, intracranial pressure monitoring, and neuropsychological tests, to
    help them accurately diagnose normal pressure hydrocephalus and rule out
    any other conditions.

    The symptoms described in this section account for the most typical ways in
    which progressive hydrocephalus manifests itself, but it is important to
    remember that symptoms vary significantly from one person to the next.

    How is hydrocephalus diagnosed?

    Hydrocephalus is diagnosed through clinical neurological evaluation and by


    using cranial imaging techniques such as ultrasonography, computed
    tomography (CT), magnetic resonance imaging (MRI), or pressure-monitoring
    techniques. A physician selects the appropriate diagnostic tool based on an
    individuals age, clinical presentation, and the presence of known or suspected
    abnormalities of the brain or spinal cord.

    What is the current treatment?

    Hydrocephalus is most often treated by surgically inserting a shunt system.


    This system diverts the flow of CSF from the CNS to another area of the body
    where it can be absorbed as part of the normal circulatory process.

    A shunt is a flexible but sturdy plastic tube. A shunt system consists of the
    shunt, a catheter, and a valve. One end of the catheter is placed within a
    ventricle inside the brain or in the CSF outside the spinal cord. The other end
    of the catheter is commonly placed within the abdominal cavity, but may also
    be placed at other sites in the body such as a chamber of the heart or areas
    around the lung where the CSF can drain and be absorbed. A valve located
    along the catheter maintains one-way flow and regulates the rate of CSF flow.
    A limited number of individuals can be treated with an alternative procedure
    called third ventriculostomy. In this procedure, a neuroendoscope a small
    camera that uses fiber optic technology to visualize small and difficult to reach
    surgical areas allows a doctor to view the ventricular surface. Once the
    scope is guided into position, a small tool makes a tiny hole in the floor of the
    third ventricle, which allows the CSF to bypass the obstruction and flow toward
    the site of resorption around the surface of the brain.

    What are the possible complications of a shunt system?

    Shunt systems are not perfect devices. Complications may include mechanical
    failure, infections, obstructions, and the need to lengthen or replace the
    catheter. Generally, shunt systems require monitoring and regular medical
    follow up. When complications occur, the shunt system usually requires
    some type of revision.

    Some complications can lead to other problems such as overdraining or


    underdraining. Overdraining occurs when the shunt allows CSF to drain from
    the ventricles more quickly than it is produced. Overdraining can cause the
    ventricles to collapse, tearing blood vessels and causing headache,
    hemorrhage (subdural hematoma), or slit-like ventricles (slit ventricle
    syndrome). Underdraining occurs when CSF is not removed quickly enough
    and the symptoms of hydrocephalus recur. In addition to the common
    symptoms of hydrocephalus, infections from a shunt may also produce
    symptoms such as a low-grade fever, soreness of the neck or shoulder
    muscles, and redness or tenderness along the shunt tract. When there is
    reason to suspect that a shunt system is not functioning properly (for example,
    if the symptoms of hydrocephalus return), medical attention should be sought
    immediately.

    What is the prognosis?

    The prognosis for individuals diagnosed with hydrocephalus is difficult to


    predict, although there is some correlation between the specific cause of the
    hydrocephalus and the outcome. Prognosis is further complicated by the
    presence of associated disorders, the timeliness of diagnosis, and the success
    of treatment. The degree to which relief of CSF pressure following shunt
    surgery can minimize or reverse damage to the brain is not well understood.

    Affected individuals and their families should be aware that hydrocephalus


    poses risks to both cognitive and physical development. However, many
    children diagnosed with the disorder benefit from rehabilitation therapies and
    educational interventions and go on to lead normal lives with few limitations.
    Treatment by an interdisciplinary team of medical professionals, rehabilitation
    specialists, and educational experts is critical to a positive outcome. Left
    untreated, progressive hydrocephalus may be fatal.
    The symptoms of normal pressure hydrocephalus usually get worse over time
    if the condition is not treated, although some people may experience
    temporary improvements. While the success of treatment with shunts varies
    from person to person, some people recover almost completely after treatment
    and have a good quality of life. Early diagnosis and treatment improves the
    chance of a good recovery.

    What research is being done?

    The National Institute of Neurological Disorders and Stroke (NINDS) and other
    institutes of the National Institutes of Health (NIH) conduct research related to
    hydrocephalus in laboratories and clinics at the NIH and support additional
    research through grants to major medical institutions across the
    country. Much of this research focuses on finding better ways to prevent,
    treat, and ultimately cure disorders such as hydrocephalus. The NINDS also
    conducts and supports a wide range of fundamental studies that explore the
    complex mechanisms of normal and abnormal brain development.

    Prepared by: Office of Communications and Public Liaison National Institute of


    Neurological Disorders and Stroke National Institutes of Health Bethesda, MD
    20892

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