Hydrocephalus is a condition in which the primary characteristic is excessive accumulation of fluid in the brain. Although hydrocephalus was once known as “water on the brain,” the “water” is actually cerebrospinal fluid (CSF) — a clear fluid surrounding the brain and spinal cord.
The excessive accumulation of CSF results in an abnormal dilation of the spaces in the brain called ventricles. This dilation causes potentially harmful pressure on the tissues of the brain.
Hydrocephalus may be congenital or acquired. Congenital hydrocephalus is present at birth and may be caused by genetic abnormalities or developmental disorders such as spina bifida and encephalocele. Acquired hydrocephalus develops at the time of birth or at some point afterward and can affect individuals of all ages. For example, hydrocephalus ex-vacuo occurs when there is damage to the brain caused by stroke or traumatic injury.
Normal pressure hydrocephalus occurs most often among the elderly. Although many people develop normal pressure hydrocephalus without an obvious cause, it may result from:
- A subarachnoid hemorrhage
- Head trauma
- Complications of surgery
Symptoms of hydrocephalus vary with age, disease progression, and individual differences in tolerance to CSF.
In infancy, the most obvious indication of hydrocephalus is often the rapid increase in head circumstance or an unusually large head size. In older children and adults, symptoms may include:
- Headache followed by vomiting
- Papilledema – swelling of the optic disk, which is part of the optic nerve
- Downward deviation of the eyes (called “sunsetting”)
- Problems with balance
- Poor coordination
- Gait disturbance
- Urinary incontinence
- Slowing or loss of development (in children)
- Other changes in personality or cognition, including memory loss
Hydrocephalus is diagnosed through clinical neurological evaluation and by using cranial imaging techniques such as ultrasonography, computer tomography (CT), magnetic resonance imaging (MRI), or pressure-monitoring techniques.
The symptoms of normal pressure hydrocephalus usually get worse over time if the condition is not treated, although some people may experience temporary improvements. If left untreated, progressive hydrocephalus is fatal, with rare exceptions.
The prognosis for patients diagnosed with hydrocephalus is difficult to predict, although there is some correlation between the specific cause of hydrocephalus and the patient’s outcome. Prognosis is further complicated by the presence of associated disorders, the timeliness of diagnosis, and the success of treatment.
Hydrocephalus is most often treated with the surgical placement of a shunt system. This system diverts the flow of CSF from a site within the central nervous system to another area of the body where it can be absorbed as part of the circulatory process. A limited number of patients can be treated with an alternative procedure called third ventriculostomy. In this procedure, a small hole is made in the floor of the third ventricle, allowing the CSF to bypass the obstruction and flow toward the site of resorption around the surface of the brain.
The parents of children with hydrocephalus should be aware that hydrocephalus poses risks to both cognitive and physical development. Treatment by an interdisciplinary team of medical professionals, rehabilitation specialists, and educational experts is critical to a positive outcome. Many children diagnosed with the disorder benefit from rehabilitation therapies and educational interventions, and go on to lead normal lives with few limitations.