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Hydrocephalus

Hydrocephalus Treatment in Delhi, India

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Overview

Hydrocephalus is a medical condition characterised by the accumulation of excessive amounts of cerebrospinal fluid (CSF) within the brain's ventricles. Hydrocephalus, as the term suggests, is derived from the Greek words "hydro", which refers to water, and "cephalus", which means the head.

Cerebrospinal fluid is a clear, colourless, organic fluid which surrounds the brain and spinal cord. It circulates within the ventricles of the brain. It serves various essential functions, such as acting as a shock absorber for the brain and spinal cord regions, supplying multiple crucial nutrients to the brain, eliminating waste products from the brain, and regulating pressure changes in the brain. When cerebrospinal fluid accumulates around the brain's tissues, it can lead to uneven pressures on the tissues of the brain, which are present inside the skull. Accumulation of cerebrospinal fluid mainly occurs when there is either increased production of the liquid or a decrease in the rate of absorption of cerebrospinal fluid.

Hydrocephalus can occur in any age group, although it is more frequently seen in infants and individuals above 60. The majority of these cases are diagnosed either at the time of birth or during early childhood.

Hydrocephalus can result in brain damage leading to developmental, physical and intellectual impairments. Therefore, prompt medical attention is needed to avoid serious complications.

Types of Hydrocephalus

  • Communicating Hydrocephalus: It occurs when the flow of cerebrospinal fluid is restricted after it leaves the ventricles. In this type of Hydrocephalus, CSF can still flow between the ventricles.
  • Normal Pressure Hydrocephalus (NPH) This form of communicating Hydrocephalus occurs among people of any age but is most common among the elderly. It is caused due to subarachnoid haemorrhage, head trauma, infection, tumour or surgery complications. However, specific individuals develop this condition due to unknown reasons. In that case, it is termed Idiopathic normal pressure hydrocephalus.
  • Non-communicating Hydrocephalus: It is also called Obstructive Hydrocephalus and occurs when cerebrospinal fluid flow is blocked along one or more of the narrow passages that connect the ventricles. One of the most prominent causes is aqueductal stenosis, which narrows the small passage between the third and fourth ventricles in the middle of the brain.     

Classification of Hydrocephalus

Hydrocephalus may also be classified as congenital or acquired:

  • Congenital Hydrocephalus is present at the time of birth and is caused by specific events during fetal development or genetic abnormalities. In very rare cases, Congenital Hydrocephalus may not cause any symptoms during childhood, but they only become prominent in adulthood and may be associated with Aqueductal stenosis
  • Acquired Hydrocephalus: It can develop at birth or during the early childhood phase

Symptoms of Hydrocephalus

The symptoms of Hydrocephalus vary from one child to another and among different age groups. The following are the symptoms of Hydrocephalus:

Among Infants

  • The extra-large size of the head.
  • Downward deviation of eyes.
  • Vomiting
  • Irritable
  • Seizures
  • Progressive increase in the circumference of the head.
  • Sleepiness and lethargy..

Among Children

  • Blurred or double vision.
  • Gait abnormalities.
  • Nausea
  • Vomiting
  • Lack of concentration.
  • Seizures
  • Urinary incontinence
  • Lack of appetite.

Adults

Diagnosis of Hydrocephalus

The following tests are required to diagnose the condition of Hydrocephalus:

  • Neurological Examination: The neurologist tests the person's muscle strength, movement of limbs, and reflexes present to get an idea about the patient's overall condition
  • Brain Imaging Tests: These comprise of:
    1. Ultrasound: It helps to detect Hydrocephalus before birth during prenatal examinations.
    2. Magnetic Resonance Imaging (MRI): MRI scans help detect enlarged ventricles caused by the accumulation of excessive cerebrospinal fluid. It can be carried out to detect the various causes of this condition.
    3. CT Scan: These generate less detailed images than MRI and are used for emergencies.

Other diagnostic tests include:

  • Intracranial pressure monitoring.
  • Lumbar puncture.
  • Spinal tap.

Treatment of Hydrocephalus

If left untreated, Hydrocephalus can prove fatal and life-threatening. Therefore, surgical intervention is usually required in the treatment of Hydrocephalus. The surgical intervention aims to prevent further brain damage and restore the flow of cerebrospinal fluid in the brain. Surgical procedures involved in the treatment of Hydrocephalus are as follows:

  • Insertion of Shunt: Shunt is a long, flexible tube consisting of a catheter and a valve that helps flow cerebrospinal fluid at a desired, normal rate, particularly in the right direction. The doctor inserts one end of this shunt in the brain and the other in the peritoneal cavity. The shunt system remains in the patient's body forever and requires constant monitoring. In addition, it helps to maintain the intra-cranial pressure within normal limits.
  • Ventriculostomy: This surgical procedure involves making a hole at the bottom of the ventricles or between the ventricles to relieve the intracranial pressure.

Risk Factors of Hydrocephalus

These include the following:

  • Abnormal development of the Central Nervous System (CNS).
  • Bleeding within the ventricles.
  • Uterine infection during the pregnancy phase leads to inflammation in fetal brain tissues.

Other factors that contribute to this condition are as follows:

  • Brain tumour
  • Infections of the central nervous system.
  • Traumatic injury to the brain.
  • Traumatic brain injury leads to bleeding in the brain.

Prevention of Hydrocephalus

Hydrocephalus can't be prevented, but it is certainly possible to reduce the risk associated with this condition in the following ways:

  • Wearing helmets to avoid road traffic accidents.
  • Getting timely vaccinations to prevent infections related to Hydrocephalus.
  • Prenatal care during pregnancy is essential as it lowers the chances of going into premature labour.

Complications of Hydrocephalus

These are as follows:

  • Intellectual disability.
  • Developmental disability.
  • Physical disability.
  • Loss of life in severe cases.

Outlook for Hydrocephalus

In the case of children, the outlook depends on the disease's progression and the presence of any infection. A team of paediatricians, developmental therapists, physiotherapists and occupational therapists work closely with the children and help them manage their disability and reduce the long-term effects of this condition. Adults need to consult physiotherapists and occupational therapists for better outcomes.

Review

Reviewed by Dr. Manoj Khanal - Associate Director, Neurosciences, Neurology, Interventional Neurology.


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