Hydrocephalus

Hydrocephalus

Hydrocephalus also known as "water on the brain", is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain.

This may cause

increased intracranial pressure inside the skull
progressive enlargement of the head
convulsion
blurred vision , and mental disability.
Hydrocephalus can also cause death.
Although it does occur in older adults, it is more common in infants

Classification

Hydrocephalus can be caused by impaired cerebrospinal fluid (CSF) flow, reabsorption, or excessive CSF production.

The most common cause of hydrocephalus is CSF flow obstruction (e.g., stenosis of the cerebral aqueduct or obstruction of the interventricular foramina - foramina of Monro secondary to tumors, hemorrhages, infections or congenital malformations).

Hydrocephalus can also be caused by overproduction of cerebrospinal fluid (e.g., Choroid plexus papilloma, villous hypertrophy).

Based on its underlying mechanisms, hydrocephalus can be classified into

communicating and non-communicating (obstructive).
Both forms can be either congenital or acquired.

Communicating hydrocephalus, also known as non-obstructive hydrocephalus, is caused by impaired cerebrospinal fluid reabsorption in the absence of any CSF-flow obstruction between the ventricles and subarachnoid space. Various neurologic conditions may result in communicating hydrocephalus, including subarachnoid hemorrhage , intraventricular hemorrhage, meningitis and congenital absence of arachnoid villi..

Non-communicating or obstructive hydrocephalus, is caused by a CSF-flow obstruction ultimately preventing CSF from flowing into the subarachnoid space (either due to external compression or intraventricular mass lesions).

Congenital

Arnold-Chiari malformation
Dandy-Walker malformation
Aqueduct atresia and stenosis

Acquired

This condition is acquired as a consequence of CNS infections, meningitis, brain tumors, head trauma, intracranial hemorrhage.


Signs and symptoms

Acute dilatation of the ventricular system is more likely to manifest with the nonspecific signs and symptoms of increased intracranial pressure: vomiting, nausea, papilledema, sleepiness or coma. Elevated intracranial pressure may result in uncal and/or cerebellar tonsill herniation, with resulting life-threatening brain stem compression.

Infants with hydrocephalus presented with:

soft, bulge fontanelle
the head larger than expected
Eyes that appear to gaze downward
Irritability
Seizures
Separated sutures
Sleepiness
Vomiting.

Symptoms that may occur in older children can include:

Brief, shrill, high-pitched cry;
Changes in personality, memory, or the ability to reason or think;
Changes in facial appearance and eye spacing
Crossed eyes or uncontrolled eye movements
Difficulty feeding
Excessive sleepiness
Headache
Irritability
Loss of bladder control (urinary incontinence)
Muscle spasticity (spasm)
Slow growth (child 0–5 years)
Slow or restricted movement
Vomiting .


Treatment

Hydrocephalus treatment is surgical, generally utilizing various types of cerebral shunts

ventriculo-peritoneal shunt
ventriculo-atrial shunt
ventriculo-pleural shunt
Lumbar-peritoneal shunt

An alternative treatment for obstructive hydrocephalus is:

the endoscopic third ventriculostomy (ETV), whereby a surgically created opening in the floor of the third ventricle allows the CSF to flow directly to the basal cisterns, thereby shortcutting any obstruction, as in aqueductal stenosis.

Shunt complication

Examples of possible complications include :
• shunt malfunction
• shunt failure
• shunt infection
• shunt obstruction