We've all heard the story of "water filling your head." Maybe you said this as a joke, or maybe you heard it from someone and got scared. This is actually not a joke, this is a medically explainable condition. This is caused by a special type of fluid accumulating in the brain more than necessary. So today, let's talk very simply and friendly about what this Hydrocephalus is, why it happens, what are the symptoms, and what are the treatments for it. Don't be afraid, let's understand everything about this clearly.
Simply put, what is Hydrocephalus?
The word hydrocephalus comes from the Greek language. "Hydro" means "water" and "Cephalus" means "head." So the simple meaning is "filling the head with water." But here, the water that fills the head is not the water we drink.
Our brain and spinal cord are surrounded by a special fluid that acts as a shock absorber in a car. We call this cerebrospinal fluid (CSF) . It is a clear, colorless liquid. This CSF fluid has several main functions:
- Safety: This fluid keeps our brains safe and secure inside our skull, like an egg in a bowl of water.
- Nutrition: This liquid also helps provide the brain with the nutrients it needs.
- Waste removal: This also helps remove waste products from brain cells and return them to the blood.
Imagine that our brain has a system like a water tank in our house. This CSF fluid is produced, travels through chambers called ventricles in the brain, and then is reabsorbed back into the blood. This is something that happens constantly, like a cycle. The amount needed per day is produced, and the same amount is reabsorbed by the body.
Now think about it, what happens if there is a blockage somewhere in this cycle? Or, what happens if the process of reabsorbing this fluid back into the body becomes weak? That's when the problem begins. CSF fluid starts to accumulate inside the brain. As the fluid accumulates in this way, the ventricles gradually get bigger. This increases the pressure inside the skull. This excessive pressure can damage the brain and interfere with the normal functioning of the brain. That's what we call Hydrocephalus.
Who can get this condition?
Hydrocephalus is not limited to a specific age group. It can occur in people of any age.
- Newborns: Some babies are born with this condition. According to statistics, one or two out of every 1,000 babies born can have this condition.
- Young children and young adults: This can also be caused by a brain infection or accident after birth.
- Adults: Some people can develop this condition as they get older. It's called Normal Pressure Hydrocephalus (NPH). We'll talk about that in a bit.
What are the main types of hydrocephalus?
There are four main types of this disease. They are classified according to how they develop. Although the words doctors use about this are a bit complicated, let's understand them simply.
| Type | A simple explanation |
|---|---|
| Communicating Hydrocephalus | What happens in this is that after the CSF fluid comes out of the ventricles of the brain, there is a problem with its absorption back into the blood. The fluid movement between the ventricles is good, which is why it is called 'Communicating'. It's like water coming out of the pipes, but the water doesn't get absorbed into the ground. |
| Non-Communicating Hydrocephalus (Obstructive Hydrocephalus) | This occurs when one or more of the narrow channels that connect the ventricles of the brain become blocked. It's like a piece of dirt getting stuck in a water pipe. Then the CSF fluid can't flow through it and collects in one place. This is also called 'Obstructive'. |
| Normal Pressure Hydrocephalus (NPH) | This is a condition that often occurs in older people. Here too, CSF fluid accumulates in the brain and the chambers become larger. But surprisingly, the pressure inside the skull does not increase significantly. That is why it is called 'Normal Pressure'. The symptoms come on gradually, over time. |
| Hydrocephalus Ex-Vacuo | This occurs when brain tissue is damaged, such as from a severe head injury or stroke. CSF fluid then builds up to fill the space left by the damaged and shrunken parts of the brain. Here, too, the pressure usually does not increase. |
You may have heard the term Ventriculomegaly . This refers to the enlargement of the ventricles in a baby's brain while it is still in the womb. This can be due to hydrocephalus or other causes.
What are the causes of hydrocephalus?
The causes of hydrocephalus can be divided into two main categories: congenital causes and postnatal causes.
Congenital causes (Congenital Hydrocephalus)
These are the result of a combination of genetic and environmental factors as a child develops in the womb.
- Neural Tube Defects: Complications of the spine and brain, such as Spina Bifida .
- Aqueductal Stenosis: A narrowing of the passageway between the third and fourth ventricles of the brain.
- Premature birth: If the baby is born before the due date, complications such as bleeding in the brain can occur.
- Infections during pregnancy: If the mother contracts an infection like Rubella during pregnancy, it can affect the baby's brain tissue and cause inflammation.
Later causes (Acquired Hydrocephalus)
These can occur at any time in life, after birth.
- Head Trauma: A severe blow to the head or an accident.
- Stroke: Interruption of blood flow to the brain.
- Tumors in the brain or spinal cord.
- Meningitis: Infection of the brain or spinal cord.
Sometimes, Normal Pressure Hydrocephalus (NPH) can occur without an obvious cause, especially in older people.
What are the symptoms of this disease? (Varies depending on age!)
The most important thing is that the symptoms of hydrocephalus vary greatly from age to age. They can also vary depending on how advanced the disease is and how each person's body copes with this pressure.
Let's see how these characteristics affect different age groups in the table below.
| Age group | Common symptoms |
|---|---|
| Newborns (Infants) |
|
| Older Children | |
| Adults | |
| Older Adults (NPH) |
How does a doctor accurately diagnose this disease?
If you or your child has any of the above symptoms, the best thing to do is to see a qualified doctor immediately. He or she will perform a complete neurological evaluation. Then, to confirm the diagnosis, the following tests may be ordered:
- Brain Imaging Tests: These can clearly see the size of the ventricles inside the brain and whether CSF fluid has accumulated.
- Ultrasound Scan: Since the skull of young babies is not closed, this can easily look inside the brain.
- CT (Computerized Tomography) Scan: Obtaining cross-sectional images of the brain using X-rays.
- MRI (Magnetic Resonance Imaging) Scan: Obtains very clear, detailed images of the brain using a magnetic field.
- Other tests (for adults):
- Spinal Tap (Lumbar Puncture): A procedure in which a very small needle is inserted into the spinal canal to take a sample of CSF fluid. This can also measure CSF pressure.
- Intracranial Pressure (ICP) Monitoring: A small sensor is inserted into the skull and used to monitor changes in pressure inside the brain over a day or two.
What are the treatments for hydrocephalus?
First, remember this clearly. Hydrocephalus is not a condition that can be cured by taking medicine. If left untreated, it can be life-threatening. Therefore, early diagnosis and proper treatment are the only ways to achieve a good recovery.
Currently, the only treatment for this condition is surgery . There are two main types of surgery used.
1. Shunt Placement
This is the most common treatment. A shunt is a flexible, thin tube. In this surgery, one end of the tube is placed in a ventricle in the brain where CSF fluid collects. The other end of the tube is placed under the skin, usually into the abdominal cavity. The extra CSF fluid that accumulates in the brain then passes through this tube and into the abdominal cavity. There, the fluid is reabsorbed back into the body's bloodstream. This is like an extra 'drain pipe' that goes from the brain to the stomach.
2. Endoscopic Third Ventriculostomy (ETV)
This is a slightly different surgery. It involves making a very small hole in the bottom of the third ventricle of the brain. This allows the CSF to bypass the blocked path and flow through a new path. It's like creating a bypass to bypass a busy road. This surgery is usually best for children over 2 years old and some adults.
What complications can occur after treatment?
Most people live a normal life after surgery without any complications. However, sometimes problems can arise. Therefore, it is essential to stay in touch with the doctor and go to the clinics on time.
- Possible problems with the shunt: Because a shunt is a mechanical device, it can break, become blocked, or become infected. If that happens, another surgery may be needed to repair or replace it.
- Problems with ETV surgery: The hole created during ETV surgery can close again at any time.
Therefore, if you or your child has had a shunt or ETV, be very careful about the following symptoms. If any of these occur, inform your doctor immediately or go to the hospital.
- Headache, nausea, or vomiting again.
- Visual impairment.
- Excessive fatigue or drowsiness.
- Redness, swelling, or pain along the path of the shunt (under the skin).
- Fever without cause.
- Pain in the neck or shoulder muscles.
- Seizures.
So, is it possible to live a normal life with this disease?
Yes, it definitely can!
With proper surgery and regular medical supervision, most people with hydrocephalus live normal, happy lives. However, the nature of the condition and the conditions that occur after surgery can vary from person to person.
Especially if a child has this condition, it can have an impact on the child's physical and mental development. Therefore, as a parent, it is important that you work very closely with your doctor. Providing the child with the necessary physiotherapy and speech therapy can greatly support the child's development.
It's normal to feel scared and worried when you learn that someone you love has Hydrocephalus. But remember, you are not alone. Your doctor and healthcare team are there to provide you with the advice and support you need. With proper education and a well-planned approach, your loved one can also achieve their dream of living a normal, happy life.
Take-Home Message
- Hydrocephalus, or "water on the head," is an abnormal buildup of cerebrospinal fluid (CSF) in the brain. While this is a frightening, treatable condition, it is also a treatable condition.
- Symptoms vary depending on age. Be especially vigilant for symptoms such as abnormally large heads and bulging testicles in young children.
- The only treatment for this is surgery (Shunt or ETV). It cannot be cured with medication.
- After surgery, it is imperative to seek medical advice and attend clinics on time . Always be aware of the functioning of the shunt.
- With proper treatment and follow-up, most people with hydrocephalus can live normal and full lives .
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