Do you think your little one's head is a little bigger than his age? Or has an elderly family member suddenly started having difficulty walking or becoming forgetful? These could be signs of a condition called hydrocephalus, which we commonly call 'water on the brain'. Don't be alarmed when you hear this. The most important thing is to be fully aware of this condition and seek medical attention at the right time. Let's talk about this today.
Simply put, what is Hydrocephalus?
Our brain is not just a thing inside our skull. It is protected and floats in a special fluid. We call this fluid Cerebrospinal Fluid (CSF) . Like the 'shock absorber' in a car, this CSF fluid protects our brain from damage when it shakes or hits its head. Not only that, this fluid also helps to provide the brain with the necessary nutrition and remove waste products from the brain.
This CSF fluid is constantly produced in the small cavities (ventricles) inside the brain, circulated, and reabsorbed back into the body. Think of it like a water tank being filled with water, flowing through pipes, being used, and the rest being drained away.
Hydrocephalus is a condition in which, due to some disruption in this process, CSF fluid accumulates in the cavities inside the brain , creating unnecessary pressure on the brain. Just like when a water pipe is clogged, water fills up in one place and overflows. This pressure can damage brain tissue.
What symptoms change with age?
The symptoms of this condition can vary greatly depending on a person's age. Let's take a look at how it affects each age group.
| Age group | Common symptoms |
|---|---|
| Infants | |
| Young children and school-going children | |
| Adults |
What are the main causes of hydrocephalus?
There are three main reasons for this:
1. Blockage: The path through which CSF fluid flows can become blocked due to a brain tumor, fluid-filled cyst, birth defect, head injury, or stroke. This is the most common cause.
2. Poor Absorption: The brain tissue may have a reduced ability to absorb CSF fluid. This can be caused by infections such as meningitis or inflammation caused by head injuries.
3. Overproduction of fluid: In some rare cases, the brain produces more CSF fluid than the body can handle. This can also often be associated with infectious conditions.
How is the diagnosis made?
If you or your child is showing any of the above symptoms, it is essential to see a qualified doctor immediately . The doctor will first perform a physical examination and ask about the symptoms. Then, they may order tests such as:
- Neurological exam: Checking your balance, muscle strength, vision, and mental function.
- Brain scans:
- CT scan (Computerized Tomography scan): A series of cross-sectional images of the brain can be used to see if the brain cavities are enlarged or if there are any blockages.
- MRI scan (Magnetic Resonance Imaging): This helps to obtain clearer, more detailed images of the brain and CSF pathways.
- Lumbar Puncture / Spinal Tap: A small needle is inserted into the spinal cord to remove a small amount of CSF fluid. This can give an idea of the pressure inside the brain and the presence of infection.
- Intracranial Pressure Monitoring (ICP): In some cases, a small device may need to be inserted into the brain to directly measure the pressure inside the brain.
What are the treatments?
The main goal of treating hydrocephalus is to remove the excess fluid that has accumulated in the brain and reduce the pressure on the brain.
The important thing is that this condition cannot be completely cured with medication. But it can be successfully controlled with surgery and you can live a normal life.
The main treatment is to place a shunt .
Simply put, a shunt is a very thin, flexible plastic tube that is inserted under the skin. It works by diverting excess CSF fluid that builds up in the brain to another part of the body (often the abdomen) where the fluid can be easily absorbed. This is like creating a new 'bypass' for the fluid to flow through the brain. After the shunt is placed, you will need to see your doctor regularly to make sure it is working properly.
In some cases, treatment can be done without a shunt. Endoscopic Third Ventriculostomy (ETV) is one such surgery. In this procedure, a small camera (endoscope) is inserted into the brain and a new path is created for the CSF to flow through. Your doctor will decide which treatment is best for you.
Be aware of possible complications after treatment.
After a shunt is placed, it can become blocked or infected. If this happens, the symptoms of hydrocephalus will start to appear again.
Keep an eye out for these signs:
- Headache, vomiting
- Two-sided vision
- Redness and pain along the path of the shunt
- Unexplained fever
- Excessive sleepiness
Very important: If the child or patient is difficult to wake up or is unconscious, take them to a hospital's Emergency Treatment Unit (ETU) immediately, as they may be in a coma.
Take-Home Message
- Hydrocephalus, or 'water on the brain', is a condition in which pressure builds up in the brain due to the accumulation of CSF fluid. This is a serious condition.
- Symptoms vary by age. The main symptoms may be an enlarged head in infants, and problems with walking and memory in adults.
- It is important to seek medical advice as soon as you notice these symptoms. Early detection of the disease increases the likelihood of successful treatment.
- The main treatment is surgically inserting a shunt. This can last a lifetime and must be checked regularly to ensure it is working properly.
- Stay in touch with your doctor, follow his/her instructions carefully, and report any suspicious symptoms immediately.
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