Causative and risk factors
The cause of hydrocephalus is disturbance in the flow of cerebrospinal fluid (CSF).
CSF levels can rise in the following conditions:
- Obstruction: Due to obstruction of the flow, the CSF cannot flow normally
- Poor absorption: Decrease in the ability of blood vessels to absorb it
- Overproduction: Brain produces an excess amount of CSF
Before the birth of baby, hydrocephalus can be caused by genetic defects, failure of the closure of spinal column or maternal infections during pregnancy.
In young children, this condition can occur due to meningitis, intracranial haemorrhage, injuries or brain tumours.
Clinical presentation
The symptoms of hydrocephalus depend on age, amount of brain damage and the cause.
Infants usually present with increased head circumference and a bulging fontanel, or soft spot on the surface of the skull. The sutures may appear separated. He/she is excessively irritable or fussy with eyes that look down or fixed downwards. Other symptoms include vomiting, drowsiness and seizures.
Symptoms that may affect toddlers and older children include changes in personality, crossed eyes and other facial changes. They complain of headaches, muscle spasms and have short, high-pitched cries. Their walking and talking may be delayed. The child may be drowsy, irritable and have trouble eating. Other symptoms include loss of coordination and bladder incontinence.
The complications of hydrocephalus are extremely variable. They depend on the severity of hydrocephalus and promptness of treatment. Hydrocephalus can lead to impairment of physical and intellectual faculties. This impairment can range from mild to severe.
Diagnosis & Investigations
Your doctor will first measure the baby’s head circumference and carry out a detailed neurological exam. An ultrasound of the brain is performed. An ultrasound can also detect congenital hydrocephalus before the baby is born.
Other imaging tests such as an X ray of the skull and CT/MRI scan of the brain are performed. Very rarely, lumbar puncture with CSF examination is advised.
Treatment
Surgery is the primary treatment for hydrocephalus. The commonly performed procedures are insertion of a shunt and ventriculostomy.
Shunt insertion – A shunt (long, flexible tube) is introduced in the body wherein 1 end is in a brain ventricle and the other end is introduced in another body part such as the abdomen. The purpose of shunting is to drain away the excess fluid from around the brain.
Ventriculostomy – This procedure is an alternative for shunt insertion. In this procedure a hole is made in the bottom of the ventricles or in between the ventricles to drain away the excess fluid.
About 50% of children with hydrocephalus will die if timely treatment is not provided. On the other hand, some children may recover completely without any lasting impairments.
