Have you ever heard of "water filling your head"? Maybe one of your family members, a friend, or a small child has had this condition. What exactly is it? Although it may seem a little scary, if you are properly informed, you can reduce many problems. Today we are talking about this condition called Hydrocephalus .
What is Hydrocephalus?
Simply put, hydrocephalus is an abnormal buildup of fluid inside your brain . "Hydro" is Greek for "water" and "cephalus" for "head." It used to be called "water in the head." But this "water" is actually a clear, colorless liquid called cerebrospinal fluid (CSF) . This fluid surrounds your brain and spinal cord.
Imagine, inside our brain there are small chambers called ventricles . This CSF fluid flows through these chambers. This CSF fluid provides the brain with the nutrients it needs and removes waste products from the brain. Also, this CSF fluid surrounds our brain and spinal cord like a cushion, protecting it from any danger . Then this CSF fluid is absorbed back into our blood.
Normally, our body produces the amount of CSF it needs each day and then reabsorbs the same amount. It is a balanced process. However, if there is any obstruction to the flow or absorption of this CSF fluid , then the problem starts. When this happens, the CSF fluid starts to accumulate, and the ventricles of the brain become larger. This increases the pressure inside the head. When this pressure increases, the brain cannot function properly.
Who can develop hydrocephalus?
According to statistics in the United States, one or two out of every 1,000 babies born can be born with this condition. However, we must remember that this is not just for small babies, but can also affect older children, adults, the elderly, and anyone of any age .
What are the main types of hydrocephalus?
There are four main types of hydrocephalus. Let's take a look at what they are.
1. Communicating Hydrocephalus:
This occurs when the CSF fluid, after it has left the ventricles of the brain, becomes blocked somewhere along the path it is flowing. This can be due to a thickening of the membranes at the base of the brain, such as the arachnoid . This is called "communicating" because the CSF fluid can still flow between the ventricles of the brain, meaning the ventricles are open.
2. Non-communicating Hydrocephalus / Obstructive Hydrocephalus:
What happens in this is that one or more of the small arteries that connect the ventricles of the brain become blocked, like a water pipe getting stuck in the middle.
3. Normal Pressure Hydrocephalus (NPH):
This is a little different. Here, too, the CSF fluid accumulates and the ventricles of the brain become larger, but the pressure inside the head does not increase suddenly, or it increases very little. The difference in NPH compared to other types is that, despite the excess CSF fluid, the pressure inside the ventricles is at a normal level. This CSF fluid accumulates slowly, so symptoms appear over time. NPH is most common in older people.
4. Hydrocephalus ex-vacuo:
This happens when the brain is damaged, such as from a head injury or stroke . When this happens, the brain tissue around the ventricles of the brain shrinks. CSF fluid then builds up to fill the space. Even though the ventricles are enlarged, the pressure inside the brain is usually normal.
When talking about this, you may also hear the term ventriculomegaly . This means that the ventricles of the fetus's brain have become enlarged. This can be due to hydrocephalus, but these chambers can also become enlarged for other reasons.
What are the causes of hydrocephalus?
Hydrocephalus can develop for a variety of reasons. It can be congenital or acquired .
Causes of Congenital Hydrocephalus:
This can be caused by a combination of genetic and environmental factors while the baby is developing in the womb. The main causes are:
- Spina bifida and other neural tube defects of the brain and spinal cord.
- Aqueductal stenosis is a narrowing of the passage between the third and fourth ventricles of the brain.
- Complications of premature birth, for example, bleeding inside the brain chambers.
- Infections such as rubella that the mother contracts during pregnancy can cause swelling of the baby's brain tissue.
Causes of acquired hydrocephalus:
This can occur at any time after birth, at any age. The main causes are:
- Severe head injuries (head trauma).
- Stroke.
- Tumors that form in the brain or spinal cord.
- Infections of the brain or spinal cord, such as meningitis .
In addition, normal pressure hydrocephalus (NPH) can develop due to bleeding or complications from surgery. Some people develop NPH for no apparent reason.
What are the symptoms of Hydrocephalus?
Symptoms vary with age, disease progression, and how well a person tolerates the accumulation of CSF fluid.
Symptoms in infants:
- The baby's head is unusually large.
- The fontanel on the top of the baby's head appears to be bulging .
- The baby's eyes are turned downward, looking like the sun is setting (sun-setting eyes) .
- Vomiting .
- Constant drowsiness and lethargy.
Symptoms in older children:
- Headache.
- Nausea and vomiting.
- Visual impairment (e.g. double vision, blurred vision).
- Developmental delays (e.g., delayed speech, walking, learning disabilities).
Symptoms in adults:
- Headache.
- Nausea and vomiting.
- Visual impairment.
- Always feeling tired.
- Balance and coordination problems (e.g., staggering when walking).
- Short-term memory loss (e.g. forgetting recent events).
Symptoms in older adults (often in NPH):
- Gait disturbances (e.g., walking with small steps and legs apart, with difficulty).
- The basic symptoms of dementia are gradual memory loss.
- Forgetfulness.
- Loss of bladder control.
How is Hydrocephalus diagnosed?
This is diagnosed through a neurological evaluation. Your doctor may use imaging techniques such as an ultrasound scan, a computer tomography (CT) scan, or a magnetic resonance imaging (MRI) scan to examine your brain.
More tests are being done to identify this condition in adults. These are:
- Spinal tap/lumbar puncture.
- Intracranial pressure monitoring (ICP): In this, a small device is inserted into the brain to measure the pressure inside the brain.
- Fundoscopic exam: This involves examining the optic nerve inside the eye with a special instrument.
Does hydrocephalus just get better?
No. This is a condition that does not just get better. If left untreated, it can be life-threatening. Therefore, if the disease is recognized early and treated successfully, the chances of a good recovery are much higher.
Can Hydrocephalus be treated?
Yes. Hydrocephalus can be treated. Although there is currently no way to completely cure it or prevent it from developing, it is treated with surgery.
How is Hydrocephalus treated?
The only current treatment is brain surgery . There are two main types of surgery to treat hydrocephalus:
1. Placing a Shunt:
This is the most common treatment. A shunt is a flexible tube that is placed inside the brain and carries the excess CSF fluid to another part of the body (often the abdominal cavity). There, the fluid is absorbed into the body. Think of it like putting a tube through your nose to drain excess water.
2. Endoscopic Third Ventriculostomy (ETV):
In this surgery, a small hole is made in the bottom of the third ventricle of the brain. This creates a path for CSF fluid to flow normally into and around the brain. This surgery is usually done on children over 2 years old.
What are the complications of hydrocephalus treatment?
Many people live well for years without any complications. However, problems can arise suddenly. People with shunts need to have regular medical checkups. The shunt can break, stop working properly, or become infected. If that happens, you may need to have another brain surgery. The opening created by ETV surgery can also close again at any time, which is also dangerous.
If you experience any symptoms of a shunt problem or ETV blockage, you should seek medical attention immediately. These symptoms may be similar to the early signs of hydrocephalus:
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* Headache
* Vision impairment
* Nausea or vomiting
* Always tired
Or new features like these may come:
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* Muscle pain in the neck or shoulders
* Seizures
* Redness or pain when touched at the site of the shunt
* Low fever
What is the future of someone with hydrocephalus?
With proper surgery, proper medical care, and regular follow-up, most people with hydrocephalus can live normal, happy lives. However, the condition and complications from surgery can vary from person to person. Therefore, it is important to work with your doctor to get the treatment and advice you need.
Especially when children have hydrocephalus, it can affect their mental and physical development. Therefore, parents of children with hydrocephalus should talk to their doctors and work to get the best results for their child.
It's normal to feel scared when you learn that someone you love has hydrocephalus. But remember, you're not alone. Your doctor can provide you and your family with the support and knowledge you need. With the right information, planning, and action, your loved one's dream of living a normal, happy life can come true.
Final Take-Home Message
Hydrocephalus is a condition in which CSF fluid builds up inside the brain. It can develop in people of any age.
- It is very important to recognize the symptoms early. Especially if your baby's head is getting bigger, the crown is bulging, or the eyes are turned downward, take them to a doctor immediately.
- This is a condition that can be treated with surgery . Shunt placement or ETV surgery is the main treatment.
- Medical supervision is always necessary after treatment, as problems with the shunt can occur.
- Don't worry. With proper treatment and medical advice, most people can live a normal life.
- If you or someone you know has these symptoms, seek medical advice immediately.
I hope this information is useful to you. Stay healthy!
` Hydrocephalus, water in the brain, CSF, cerebrospinal fluid, shunt, ETV, brain surgery
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