What is Hydrocephalus?

Hydrocephalus is essentially an abnormal buildup of cerospinal fluid in the brain ventricles, which are spaces in the brain that are filled with cerebrospinal fluid that circulates around the spinal cord within the spinal canal. Currently, no cure exists for hydrocephalus and as result all medical attention is referred to as treatment. In most cases hydrocephalus will affect the patient for the rest of his life. There are two forms of hydrocephalus: communicating hydrocephalus which is caused by absorption of cerebrospinal fluid (CSF) due to the ventricular pathways not being obstructed, and noncommunicating hydrocephalus which is caused by blockage in the ventrical pathways. In addition, hydrocephalus can form either congenitally as a result of a birth defect, or it can be acquired postpartum through infection.

Diagnosis of hydrocephalus occurs through imaging such as X Rays, ultrasound, and computed tomography scan (CT scan). Obviously, magnetic resonance imaging (MRI) is also utilized, specifically as a method for assessment of the existence and location of obstructions. In addition and MRI is used to detect changes in the brain tissue that have occurred as a result of the hydrocephalus. A spinal tap is sometimes performed in determining the cause when infection is suspected.

Symptoms vary, but the most physical indication among infants is a larger than normal head, or a faster than normal increase in the growth of the head. Other common symptoms include abnormal drowsiness and irritability, as well as vomiting and even seizures. That symptom of irritability is the single most common sign of hydrocephalus in infants and if not treated very often leads to lethargy. Another early warning sign of hydrocephalus is if there is a bulging in the soft areas on the skull known as fontanels. The natural fusion of these bones in the skull are prevented in infants where hydrocephalus occurs. The result is an abnormal expansion of the skull.

The most common treatment is through surgical placement of shunts, which is designed to divert the CSF to a part of the body where it will be more adequately absorbed. One end of the shunt is located in the CNS and the other typically placed within the peritoneal cavity with a valve installed to maintain and regulate the flow of CSF. Unfortunately, the shunt system brings with it certain potential problems. Among the possible complications include the device failing to work properly and an increased possibility for infection. In addition, the shunts must be monitored and can require another surgery to either replace or repair the catheter.

In certain cases, patients may be treated with a procedure known as a third ventriculostomy, in which a tiny camera enables the surgeon to make a small incision inside the third ventricle that will create a bypass to the obstruction, thereby causing the CSF to flow more freely.

Symptoms of elevated-pressure hydrocephalus include:

  • headache

  • nausea and vomiting, especially in the morning

  • lethargy

  • disturbances in walking

  • double vision

  • subtle difficulties in learning and memory

  • delay in children achieving developmental milestones