What is Hydrocephalus?

What is Hydrocephalus? Key Causes, Signs & Treatment Options

CSF is a clear liquid around the brain and spinal cord that cushions them and transports essential nutrients. When the brain’s CSF accumulates in the brain, it leads to a condition known as hydrocephalus. This increased pressure can harm the brain and interfere with its functions.

Hydrocephalus may exist since birth or it may develop over the years. Recognizing the causes, symptoms, and treatment options for hydrocephalus is important for early diagnosis and proper care. This article provides key information on hydrocephalus, its symptoms and how it is diagnosed and treated.

What are the Types of Hydrocephalus?

There are four main types of hydrocephalus:

• Communicating Hydrocephalus: This happens when CSF flow is blocked after it leaves the ventricles. The ventricles stay open and connected, so the fluid can still move between them. The blockage is usually at the base of the brain, caused by thickened tissue called the arachnoid membrane.
• Normal Pressure Hydrocephalus (NPH): In this type, CSF builds up slowly, making the ventricles larger. However, the pressure inside the brain doesn’t rise much. This type often affects older adults and symptoms appear gradually.
• Hydrocephalus Ex-Vacuo: This happens when brain tissue shrinks due to damage from a stroke or injury. The ventricles fill with more CSF to take up the extra space, but the pressure usually stays normal.
• Non-Communicating Hydrocephalus: Also known as obstructive hydrocephalus, this occurs when something blocks the CSF flow between the ventricles. The blockage is usually in one of the narrow passages.
   

What are the Causes of Hydrocephalus?

Hydrocephalus may be present at birth (congenital) or develop later in life (acquired), with different causes associated with each type:

• Congenital Hydrocephalus: This type starts before or during birth. It can be caused by:
  
  
  • Spina bifida or other birth defects of the brain or spine.
  • A narrowing in the brain’s fluid pathways (especially between the third and fourth ventricles).
  • Bleeding in the brain in premature babies.
  • Infections during pregnancy, like rubella, which can inflame the baby’s brain.
     
• Acquired Hydrocephalus: This type can happen at any age after birth. Causes include:
  
  
  • Head injuries.
  • Strokes.
  • Tumors in the brain or spine.
  • Infections such as meningitis.
  • Bleeding in the brain or complications from surgery can also cause normal pressure hydrocephalus. Sometimes, the cause of NPH is unknown.
     

What are the Symptoms of Hydrocephalus?

Symptoms vary depending on age, how advanced the condition is, and how well the person handles the extra fluid.
 

• In Babies:
  
  
  • Head size grows too fast.
  • Soft spots on the head bulges.
  • Eyes that look downward (called sun-setting eyes).
  • Vomiting.
  • Extreme sleepiness.
     
• In Older Children:
  
  
  • Headaches.
  • Vomiting and nausea.
  • Trouble with vision.
  • Delayed development.
     
• In Adults:
  
  
  • Headaches.
  • Nausea and vomiting.
  • Blurry vision.
  • Tiredness.
  • Problems with balance and coordination.
  • Trouble remembering things short-term.
     
• In Seniors:
  
  
  • Walking problems.
  • Mild memory loss or confusion.
  • Trouble controlling the bladder.
     

How is Hydrocephalus Diagnosed?

Doctors diagnose hydrocephalus by doing a full neurological check-up and using brain imaging tools like:

• Ultrasound
• CT scan
• MRI
   

In adults, more tests might be needed:

• Lumbar puncture (spinal tap): To check CSF pressure or remove some fluid.
• Intracranial pressure monitoring (ICP): A device is put in the brain to measure pressure.
• Eye exam (fundoscopy): To look at the optic nerve for signs of increased pressure.
   

How is Hydrocephalus Treated?

The only way to treat hydrocephalus is through brain surgery. Two main surgical treatments are used:

• Shunt System: A flexible tube is placed in the brain to drain extra CSF to another part of the body, often the belly, where it can be absorbed. This is the most common treatment.
• Endoscopic Third Ventriculostomy (ETV): A small hole is made in the bottom of the third ventricle. This creates a new path for the fluid to flow. It is mostly used in children over age two.
   

What are the Possible Complications from Treatment?

Some people live many years without problems after surgery, but issues can still occur. See your doctor right away if symptoms of treatment failure show up. These may include signs of hydrocephalus like:

• Headaches.
• Blurred or double vision.
• Vomiting.
• Tiredness.
• Stiff or sore neck and shoulders.
• Seizures.
• Redness, swelling, or pain along the shunt path.
• Mild fever.
   

The severity of hydrocephalus varies from mild to severe. Hence, early identification is required to treat it appropriately and avoid major complications. With proper treatment, many individuals can lead healthy, active lives. Regular medical care and monitoring are important to ensure overall well-being.