Hydrocephalus refers to the buildup of fluid in the cavities of the skull which leads to the swelling of the brain. This causes brain damage due to the increase in the pressure on the brain resulting in physical, developmental and intellectual impairment of the affected person. This condition can be fatal if timely treatment is not provided.
Symptoms of hydrocephalus vary with age due to the difference in their tolerance levels to the condition. They also change with the progression of the disease.
In babies born with hydrocephalus (congenital hydrocephalus), the physical features include:
- Unusually large head size
- Thin scalp with visible veins
- Downward looking eyes
- A bulging fontanel, i.e. a soft spot on the top of the baby’s head
Additionally, the child will have difficulty with feeding, vomiting, muscle stiffness or spasms in the lower limbs and difficulty with sleep.
In children who have acquired hydrocephalus after birth or in adults, the symptoms may include:
- Headache that worsens after getting up in the morning
- Blurring of vision
- Difficulty to walk
- Neck pain
- Nausea and vomiting
- Sleepiness which can progress to coma
- Inability to control the bladder or sometimes bowel movements
Hydrocephalus occurs when there is an increase in the volume of cerebrospinal fluid (CSF) that circulates through the brain and the spinal cord. There is an increase in CSF due to the following reasons:
- Excess production of CSF
- Ability of the blood vessels to absorb the CSF gets impaired
- Restricted flow of CSF due to blockage
Although hydrocephalus can develop in people of any age group, it is more common in children and adults aged above 60 years. Certain developmental and medical problems can increase the risk of developing hydrocephalus. These include:
- Lesions or tumors in the brain or spinal cord
- Bleeding in the brain due to head injury or stroke
- Certain infections of the central nervous system such as meningitis or mumps
- Birth defects
- Genetic abnormalities
If the doctor suspects hydrocephalus from the symptoms experienced by the person, he/she will perform a physical examination. This includes checking for the presence of slowed reflexes, bulged fontanel, sunken eyes and larger head circumference than the normal.
Neurological examination includes checking for:
- Muscle conditions such as reflexes, strength and tone
- Sensory status including vision, sense of hearing and the sense of touch
- Motor status including balance and coordination
- Mental status
Further, the below tests may be ordered:
Imaging tests such as an ultrasound or an MRI (magnetic resonance imaging) or a CT (computerized tomography) scan may be required to detect the underlying cause of hydrocephalus. They can also detect structural changes such as enlargement of the ventricles associated with the increase in CSF.
Hydrocephalus can be life-threatening if appropriate treatment is not provided. Treatment may not help in reversing the brain damage that has previously occurred. However, further damage can be prevented by restoring the normal flow of CSF. Hydrocephalus needs to be repaired by a surgical approach. The options include:
- Shunt surgery is the method in which a small, thin tube known as shunt is implanted in the brain. This shunt drains the excess fluid to any other part of the body, usually towards the tummy. From this place it is absorbed into the blood stream. The valve placed in the shunt controls the rate at which the CSF flows inside.
- Endoscopic third ventriculostomy (ETV) is a surgical method in which a hole is made on the floor of the brain. The trapped CSF escapes into the surface of the brain from where it gets readily absorbed into the blood stream. This method is suitable only if obstruction in the flow of CSF is the cause of hydrocephalus.
Hydrocephalus cannot be prevented; however, there are some ways to reduce the risk of developing this condition. The preventive measures are as follow.
- Children and adults are always recommended to wear a helmet while riding bicycles, motor bikes or any other vehicles.
- Wearing a seat belt is a must while driving as it ensures the individual’s safety.
- Follow the list of vaccinations and screenings scheduled to prevent the development of infectious diseases.
- Pregnant women are recommended to visit the doctor for regular prenatal checkup to prevent complications.