As the name implies, it is a condition in which there is excessive accumulation of cerebrospinal fluid (CSF) in the brain. It 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) acting as a cushion or "shock absorber"2) to provide 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. Since 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 causes hydrocephalus. Hydrocephalus affects approximately 1 in every 500 children. Different types of hydrocephalus It may be congenital or acquired. Congenital hydrocephalus: present at birth and may be caused by either events or influences that occur during fetal development, or genetic abnormalities. Acquired hydrocephalus: develops 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: flow of CSF is blocked after it exits the ventricles. This named because the CSF can still flow between the ventricles, which remain open. Non-communicating hydrocephalus – ("obstructive") - the flow of CSF is blocked along one or more of the narrow passages connecting the ventricles. There are two other forms 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 in stroke or traumatic,(brain tissue may actually shrink.) Normal pressure hydrocephalus: can happen to people at any age, most common among the elderly. It is due to 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. Common causes • "Aqueductal stenosis." (narrowing of the aqueduct of Sylvius, a small passage between the third and fourth ventricles in the middle of the brain.) • Inherited genetic abnormalities (such as the genetic defect that causes aqueductal stenosis) • Developmental disorders (such as those associated with neural tube defects including spina bifida and encephalocele). • Complications of premature birth : intraventricular hemorrhage • Diseases : meningitis, tumors, traumatic head injury, or subarachnoid hemorrhage
The following are some of the symptoms of Hydrocephalus: It varies 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: • Rapid increase in head circumference or an unusually large head size. • Vomiting • Sleepiness • Irritability • Downward deviation of the eyes (also called "sunsetting") • Seizures. Older children and adults: • 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: • Problems with walking • Impaired bladder control leading to urinary frequency and/or incontinence • Progressive mental impairment and dementia. • General slowing of movements or complain that his or her feet feel "stuck. Diagnosis: • Brain scans (CT and/or MRI) • Spinal tap or lumbar catheter • Intracranial pressure monitoring • Neuropsychological tests
Current treatments: • Hydrocephalus is most often treated by surgically inserting a shunt system. • A limited number of individuals can be treated with an alternative procedure called third ventriculostomy with neuroendoscope Possible complications of a shunts: • Mechanical failure • Infections • Obstructions • There is need to lengthen or replace the catheter. • It require monitoring and regular medical follow up. • Over draining or under draining.
