Hydrocephalus also described as “water on the brain”, is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (cavities that contain fluid) of the brain and increases the pressure within the head. ‘Hydro’ simply means water, and ‘cephalus’ refers to the head. The water on the brain is actually cerebrospinal fluid (CSF), a clear fluid surrounding the brain and spinal cord.

The CSF works by acting as a ‘shock absorber’ for the brain and spinal cord, vehicle for delivering nutrients to the brain, removing wastes, and regulation of changes in pressure within the brain.

The condition Hydrocephalus can occur at any age, but most common in infants and adults age 60 and older. The bulk of these cases are diagnosed before birth, at the time of delivery, or in early childhood.

 

What are the common causes of Hydrocephalus?

  • Hydrocephalus can be inherited genetically or associated with other developmental disorders such as spina bifida (spine defect) and encephalocele (brain hernia).
  • Bleeding within the brain
  • Brain tumors
  • Head injuries
  • Complications of premature birth

 

Symptoms of Hydrocephalus

Symptoms vary greatly from person to person. In infants

  • Abnormal enlargement of the head
  • Soft spot (fontanel) tense and bulging
  • Scalp can appear thin
  • Bones separated in baby’s head
  • Prominent scalp veins
  • Vomiting
  • Drowsiness
  • Irritability
  • Seizures
  • Poor appetite

 

In Toddlers/Children

Abnormal enlargement of baby’s head, nausea and vomiting, headache, blurred or double vision, unstable balance, irritability, delayed progress in walking or talking, poor coordination, change in personality, inability to concentrate, loss of sensory motor functions. Staying awake may be difficult for older children.

In Young and middle-aged adults

Difficulty in remaining awake or waking up, loss of balance and coordination, bladder control problems, impaired vision that may affect personal skills.

In Older adults

Unbalanced gait, memory loss, headache, bladder control problems, loss of coordination or balance. Hydrocephalus can either be congenital or normal pressure type when categorized for age groups.

 

Diagnosis of Hydrochephalus

  • Through history taking and a thorough physical examination.
  • Neurological examination that will help to determine the severity of your condition.
  • Investigations such as ultrasound, CT scan, magnetic resonance imaging (MRI).

 

When surgery is necessary

There are varieties of ways to treat hydrocephalus. One of this is directly removing the cause of CSF obstruction or diverting the excess fluid to somewhere else (another body cavity).

An indirect treatment is done by implanting a device known as a shunt to divert the excess CSF away from the brain. The shunt system continuously performs this function, thereby keeping the intracranial pressure within normal limits.

In some cases, two procedures are done, one to divert the CSF, and another at a later stage to remove the cause of obstruction (e.g., a brain tumor).

 

Recovery

Long term follow up is required for hydrocephalus as it is an ongoing condition. Post surgery, your doctor will assess for neurological problems through follow up diagnostic tests including CT Scans, MRIs and x-rays, helpful in determining if the shunt is working properly. Contact your physician if you experience any of the following postoperative symptoms

  • Nausea, vomiting, headache or double vision
  • Fever
  • Abdominal pain
  • Irritability or drowsiness
  • Redness, tenderness, pain or swelling of the skin along the incision site.

 

Prognosis

This depends on the cause, and extent of symptoms. Some show a dramatic improvement while others do not. In general, the earlier hydrocephalus is diagnosed, the better the chance for successful treatment.