Hydrocephalus: Difference between revisions
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==[[Hydrocephalus risk factors|Risk Factors]]== | ==[[Hydrocephalus risk factors|Risk Factors]]== | ||
==Natural History, Complications and Prognosis | ==[[Hydrocephalus Natural History, Complications and Prognosis|Natural History, Complications and Prognosis]]== | ||
[[ | ==[[Hydrocephalus Diagnosis|Diagnosis]]== | ||
[[Hydrocephalus Diagnosis#history and symptoms |Symptoms]], [[Hydrocephalus Diagnosis#Physical Examination|Physical Examination]], [[Hydrocephalus Diagnosis#CT|CT]] | |||
===Imaging Findings=== | ===Imaging Findings=== | ||
== Treatment == | == Treatment == | ||
Revision as of 05:56, 22 July 2012
Template:DiseaseDisorder infobox
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Hydrocephalus Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Hydrocephalus On the Web |
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American Roentgen Ray Society Images of Hydrocephalus |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun M.D., PhD.,Kalsang Dolma, MBBS
For patient information click here
Synonyms and keywords: Water on the brain
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Common Causes, Causes by Organ System, Causes In Alphabetical Order
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
Symptoms, Physical Examination, CT
Imaging Findings
Treatment
Hydrocephalus treatment is surgical. It involves the placement of a ventricular catheter (a tube made of silastic), into the cerebral ventricles to bypass the flow obstruction/malfunctioning arachnoidal granulations and drain the excess fluid into other body cavities, from where it can be resorbed. Most shunts drain the fluid into the peritoneal cavity (ventriculo-peritoneal shunt), but alternative sites include the right atrium (ventriculo-atrial shunt), pleural cavity (ventriculo-pleural shunt), and gallbladder. A shunt system can also be placed in the lumbar space of the spine and have the CSF redirected to the peritoneal cavity (LP Shunt). An alternative treatment for obstructive hydrocephalus in selected patients is the endoscopic third ventriculostomy (ETV), whereby a surgically created opening in the floor of the third ventricle allows the CSF to flow directly to the basal cisterns, thereby shortcutting any obstruction, as in aqueductal stenosis. This may or may not be appropriate based on individual anatomy. Internal hydrocephalus can be successfully treated by placing a drainage tube (shunt) between the brain ventricles and abdominal cavity to eliminate the high internal pressures. There is some risk of infection being introduced into the brain through these shunts, however, and the shunts must be replaced as the person grows. A subarachnoid hemorrhage may block the return of CSF to the circulation. If CSF accumulates in the subarachnoid space, the condition is called external hydrocephalus. In this condition, pressure is applied to the brain externally, compressing neural tissues and causing brain damage. Thus resulting to a much further damage of the brain tissue and leading to necrotization
Shunt complications
Examples of possible complications include shunt malfunction, shunt failure, and shunt infection. Although a shunt generally works well, it may stop working if it disconnects, becomes blocked, or it is outgrown. If this happens the cerebrospinal fluid will begin to accumulate again and a number of physical symptoms will develop, some extremely serious, like seizures. The shunt failure rate is also relatively high and it is not uncommon for patients to have multiple shunt revisions within their lifetime.
The diagnosis of cerebrospinal fluid buildup is complex and requires specialist expertise.
Another complication can occur when CSF drains more rapidly than it is produced by the choroid plexus, causing symptoms - listlessness, severe headaches, irritability, light sensitivity, sound sensitivity, nausea, vomiting, dizziness, vertigo, migraines, seizures, a change in personality, weakness in the arms or legs, excessive head growth (seen infants, children under age 2), strabismus, and double vision - to appear when the patient is vertical. If the patient lies down, the symptoms usually vanish in a short amount of time. A CT scan may or may not show any change in ventricle size, particularly if the patient has a history of slit-like ventricles. Difficulty in diagnosing overdrainage can make treatment of this complication particularly frustrating for patients and their families.
Resistance to traditional analgesic pharmacological therapy may also be sign of shunt overdrainage or failure. Diagnosis of the particular complication usually depends on when the symptoms appear.
Case Studies
One interesting case involving a person with past hydrocephalus was a 44-year old French man, whose brain had been reduced to little more than a thin sheet of actual brain tissue, due to the buildup of fluid in his skull. The man, who had a shunt inserted into his head to drain away fluid (which was removed when he was 14), went to a hospital after he had been experiencing mild weakness in his left leg.
In July of 2007, Fox News quoted Dr. Lionel Feuillet of Hopital de la Timone in Marseille as saying: "The images were most unusual... the brain was virtually absent."[1] When doctors learned of the man's medical history, they did a computed tomography (CT) scan and another type of scan called magnetic resonance imaging (MRI), and were astonished to see "massive enlargement" of the lateral ventricles in the skull. Intelligence tests showed the man had an IQ of 75, below the average score of 100 but not considered mentally retarded or disabled, either.
Remarkably, the man was a married father of two children, and worked as a civil servant, leading a normal life, despite having little brain tissue. "What I find amazing to this day is how the brain can deal with something which you think should not be compatible with life," commented Dr. Max Muenke, a pediatric brain defect specialist at the National Human Genome Research Institute. "If something happens very slowly over quite some time, maybe over decades, the different parts of the brain take up functions that would normally be done by the part that is pushed to the side."[2]
See also
- Spina bifida
- Acquired hydrocephalus (causes of it)
- Arachnoid granulation
- Brain
- Cerebrospinal fluid
- Intracranial pressure
- Normal pressure hydrocephalus
- Cerebral shunt
- Subarachnoid space
- Ventricular system
- HEC syndrome
References
- ↑ "Man with Almost No Brain Has Led Normal Life", Fox News (2007-07-25). Also see "Tiny brain, normal life; French doctors are puzzling over the case of 44-year-old civil servant who has led a quite normal life -- but with an extraordinarily tiny brain", Physorg.com (2007-07-20); "Tiny Brain, Normal Life", ScienceDaily (2007-07-24).
- ↑ Man Lives Normal Life Despite Having Abnormal Brain
External links
- International Federation for Spina Bifida and Hydrocephalus (IF), the umbrella organisation for national spina bifida and hydrocephalus organisations
- Hydrocephalus Association at hydroassoc.org, US
- Information on fetal hydrocephalus at fetalhydrocephalus.com
- Is the brain really necessary? at flatrock.org.nz
- Living with congenital hydrocephalus at Associated Content
Template:Diseases of the nervous system Template:Congenital malformations and deformations of nervous system
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