Hydrocephalus overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Cafer Zorkun M.D., PhD.,Kalsang Dolma, M.B.B.S.[2]
Overview
Hydrocephalus is a term derived from the Greek words "hydro" meaning water, and "cephalus" meaning head, and this condition is sometimes known as "water on the brain". People with this condition have abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head, convulsion, and mental disability.
Pathophysiology
Hydrocephalus mostly results due to CSF flow obstruction, hindering the free passage of cerebrospinal fluid through the ventricular system and it can also be caused by overproduction of cerebrospinal fluid (relative obstruction).
Epidemiology and Demographics
Hydrocephalus affects one in every 500 live births, making it one of the most common birth defects, more common than Down syndrome or deafness. There are an estimated 700,000 children and adults living with hydrocephalus, and it is the leading cause of brain surgery for children in the United States.
Risk Factors
Premature babies are often at higher risk.
Causes
Hydrocephalus is caused by impaired cerebrospinal fluid (CSF) flow, impaired CSF reabsorption, or excessive CSF production. Brain hemorrhage associated with premature birth is a common cause.
Natural History, Complications and Prognosis
Hydrocephalic children are at increased risk of various developmental disabilities such as learning disabilities, visual problems and problems with coordination.
Diagnosis
Symptoms
Symtoms of hydrocephalus are mainly due to increased intracranial pressure and depend on age, severity and cause.
Physical Examination
Physical examination shows progressive enlargement of head in infants. Depending upon the rate of development duration of hydrocephalus, signs of increased intracranial pressure may be seen.
Laboratory Studies
CT and MRI are used to evaluate ventricular size. MRI affords better imaging of the posterior fossa so can be used to evaluate posterior fossa lesion.
Treatment
- Acetazolamide and furosemide may provide temporary relief but long term results are disappointing.
- Surgery is the preferred treatment of hydrocephalus. Various shunt surgeries are done to bypass the cerebrospinal fluid flow obstruction and drain the excess fluid into other body cavities.