What is hydrocephalus? Let's talk about it in detail!

"Hydrocephalus"... It's hard to even pronounce this word, isn't it? Maybe you've never heard of this word. But if you say "water filling the head" or "water on the brain", you might be a little familiar with it. This is the medical condition we're going to talk about today. Don't worry, we'll talk about this simply, in Sinhala that you can understand.

What exactly does this head-filling-with-water thing mean?

Simply put, our brain and the spinal cord (the nerve cord that runs down our spine) are protected by a special fluid. It's like a little mattress on top. This fluid is produced inside our brain. In medicine, we call it cerebrospinal fluid . Sometimes doctors call it ``Cerebrospinal Fluid'' or ``CSF''.

Think of it this fluid called ``(CSF)`` is like the plumbing system in our house. It starts from one place, flows along certain paths, and finally gets absorbed into our bloodstream. This is what normally happens. It is like a cycle, something that happens constantly. This fluid nourishes our brain, removes unnecessary waste products, and also protects the brain from minor shocks and bruises.

So, what happens if for some reason the path through which this fluid flows is blocked, or if too much of this fluid builds up inside the brain, or if the fluid that builds up is not absorbed into the bloodstream properly? That's when the problem begins. Just like when a water pipe gets clogged and overflows, this fluid also starts to accumulate inside the brain. This is how this `(CSF)` fluid accumulates in the cavities inside the brain (which we also call `(Ventricles)`) and the pressure inside the head increases, which is what we call `(Hydrocephalus)` or ``water in the head.''

Why is this happening? What could be the reasons?

This is not the only cause of `(Hydrocephalus)`. There can be many causes. For some people, this can be something that is born with . That is, it can be due to some problem with the development of the brain while the baby is still in the womb. For example, this condition can be seen with some birth defects of the nervous system.

Also, this can happen due to reasons that occur later in life . Let's see what they are:

• Infections of the brain or spinal cord: For example, infections such as meningitis can block the pathways through which cerebrospinal fluid (CSF) flows.
• Bleeding inside the brain: Especially in babies born prematurely (we call them "premature babies"), bleeding inside the brain can occur. This condition is also possible if it occurs. Also, bleeding inside the brain can occur due to severe head injuries.
• Brain Tumors: If a tumor develops inside the brain, it can block the passageway through which cerebrospinal fluid (CSF) flows.
• Head Injuries: If the head is damaged in a severe accident, this fluid movement can also be disrupted.
• Some genetic conditions: Very rarely, some genetic causes can also cause hydrocephalus.

The most important thing is to identify and treat this condition quickly, no matter what the cause.

How do we recognize this? What are the symptoms?

The symptoms of hydrocephalus can vary from person to person. Also, these symptoms change with age.

For young babies (0 months - about 2 years)

If a little baby gets this condition, they can't say "they have a headache" like we do. So their symptoms are a little different.

• The head is getting bigger: If the baby's head is growing faster than it should be, that's a major sign. At the clinic, doctors measure the circumference of the baby's head with a tape measure to check for this.
• The foreskin looks swollen: The soft spot on the top of the baby's head, just above the forehead (what we call the foreskin), may appear swollen and hard.
• Veins are clearly visible on the scalp: Veins can be seen bulging under the skin of the scalp.
• Eyes appear to be turned downwards: As if the sun is setting, the dark circles under the eyes may appear to have sunk in. This is also called the ``Sunsetting sign''.
• Frequent vomiting.
• I don't like to drink milk and I lose weight.
• Always crying and acting irritable.
• They appear very sleepy and are difficult to wake up.
• Sometimes seizures can occur.

For older children and young people

If this condition occurs in older children and young people, the symptoms may be as follows:

• Frequent headaches: This headache may be worse when you wake up in the morning.
• Nausea and vomiting: This can be seen especially in the morning.
• Vision problems: Blurred vision in both eyes, double vision, etc.
• Difficulty walking, loss of balance.
• Excessive sleepiness, laziness.
• Behavioral changes: You may become more easily angry, agitated, or have memory loss and learning disabilities.
• Decreased control over going to the toilet.
• Things like handwriting get messy.

For adults

If an adult develops ``(Hydrocephalus),'' the symptoms may be a little different. Sometimes, these are similar to the symptoms of common diseases that occur with aging, so it may be a little late to recognize them.

• Difficulty walking: It feels like your feet are stuck to the ground, making it difficult to step.
• Memory loss and decreased thinking: Similar to symptoms of dementia.
• Difficulty controlling urine.

The combination of these three symptoms is called ``Normal Pressure Hydrocephalus - NPH''.

Important: Don't be afraid to assume you have hydrocephalus just because you have one or two of these symptoms. However, if you have more than one of these symptoms, especially if you notice a small baby's head getting bigger, it's best to seek medical advice.

How do doctors detect this?

If you or your child is showing any of these symptoms, the first thing a doctor will do is examine you thoroughly. They will listen to what you say and do a physical exam. If it's a small baby, they will measure the size of the head and examine the brain.

After that, some tests may need to be done to confirm this ``Hydrocephalus'' condition and find out what is causing it.

• Ultrasound Scan: This is often the first test done on a baby. This scan is done through the baby's skull to see the size of the fluid-filled cavities inside the brain. This is a painless and easy test.
• CT Scan (Computed Tomography Scan): This can take cross-sectional images of the brain. It can clearly see how much cerebrospinal fluid (CSF) has accumulated and how large the cavities in the brain have become.
• MRI Scan (Magnetic Resonance Imaging): This is the best test available. An MRI can produce very detailed pictures of the brain and the pathways through which the cerebrospinal fluid (CSF) flows. It can also help to determine the cause.

Based on the information obtained from these tests, the doctor will decide whether you or your child has hydrocephalus, and if so, what to do about it.

What are the treatments for this?

There are treatments for the condition ``Hydrocephalus''. The main goal is to remove the excess ``CSF'' fluid that has accumulated inside the brain and reduce the pressure inside the head.

The main treatment for this is often the placement of a shunt.

"What is a shunt?" you may be wondering. Simply put, it's a small tube. This ``(Shunt)`` is surgically placed in a fluid-filled cavity in the brain and placed in another part of the body (often the abdominal cavity). The extra fluid that builds up in the brain then travels through this tube to the abdominal cavity, where it is absorbed into the body. This helps control the pressure inside the brain.

This shunt has a small valve on one side. That controls how much fluid comes out.

Another treatment option is an endoscopic third ventriculostomy (ETV) . This involves inserting a small camera (endoscope) into the brain and creating a new path for the cerebrospinal fluid (CSF) to flow. It's like creating a new bypass around a blocked artery. Not everyone can have an ETV. Your doctor will decide which treatment is right for you.

Sometimes, if the cause of ``Hydrocephalus'' is something like a brain tumor, the condition can be cured once the tumor is removed.

Remember, don't be afraid when you hear about these surgeries. These are very advanced now. The doctors will explain them to you thoroughly.

Living with Hydrocephalus

Hydrocephalus is a condition that can sometimes be lifelong. Especially after a shunt is placed, you need to see your doctor regularly for follow-up to make sure it is working properly.

Sometimes the shunt can become blocked, rupture, or infected. If this happens, the symptoms you had before (headache, vomiting, drowsiness) may return. If this happens, you should see a doctor immediately.

A child with hydrocephalus needs special attention for their development and learning. They may sometimes need special educational needs, physiotherapy, and occupational therapy.

Living with this condition can be challenging, but with proper medical care, family support, and a positive attitude, many people can live normal lives.

Finally, things for you to remember (Take-Home Message)

• Hydrocephalus is a condition in which a watery fluid (cerebrospinal fluid - CSF) builds up inside the brain, increasing pressure inside the head.
• There can be many reasons for this. It can be caused by congenital causes as well as by later infections, injuries, tumors, etc.
• Symptoms vary depending on age. In young children, the main symptoms are an enlarged head and swelling of the brain. In older children, symptoms may include headaches, vomiting, vision problems, and difficulty walking.
• If you notice these symptoms, don't panic and seek medical advice immediately.
• This can be confirmed by scanning tests.
• Shunt surgery is often performed as a treatment.
• When living with hydrocephalus, it is very important to see your doctor regularly and follow up with their instructions.

Remember, you are not alone. If you have any more questions about this, don't be afraid to talk to your doctor. He or she will explain everything to you.

` hydrocephalus, water on the brain, cerebrospinal fluid, CSF, shunt, brain enlargement, brain surgery