Hydrocephalus occurs when excess fluid builds up in brain, most often because of an obstruction preventing proper fluid drainage. The excess fluid can push fragile brain tissues up against the skull ? causing brain damage and, if left untreated, even death. Hydrocephalus is sometimes present at birth, although it may develop later. The excessive accumulation of CSF results in an abnormal widening of spaces in the brain called ventricles. This widening creates potentially harmful pressure on the tissues of the brain.

 

Symptoms

The signs and symptoms of hydrocephalus vary by age group and disease progression.

In infants, common signs and symptoms of hydrocephalus include:

 

•  An unusually large head
•  A rapid increase in the size of the head
•  A bulging "soft spot" on the top of the head
•  Vomiting
•  Sleepiness
•  Irritability
•  Seizures
•  Eyes fixed downward (sunsetting of the eyes)
•  Developmental delay

 

In older children and adults:

 

•  Headache followed by vomiting
•  Nausea
•  Blurred or double vision
•  Eyes fixed downward (sunsetting of the eyes)
•  Problems with balance, coordination or gait
•  Sluggishness or lack of energy
•  Slowing or regression of development
•  Memory loss
•  Confusion
•  Urinary incontinence
•  Irritability
•  Changes in personality

 

Causes

The causes of hydrocephalus are

 

• Still not well understood.
• Hydrocephalus may result from inherited genetic abnormalities (such as the genetic defect that causes aqueductal stenosis)
•  Developmental disorders (such as those associated with neural tube defects including spina bifida and encephalocele).
•  Other possible causes include complications of premature birth such as intraventricular hemorrhage, diseases such as meningitis, tumors, traumatic head injury, or subarachnoid hemorrhage, which block the exit of CSF from the ventricles to the cisterns or eliminate the passageway for CSF into the cisterns.
• Hydrocephalus results when the flow of cerebrospinal fluid is disrupted — for example, when a channel between ventricles becomes narrowed — or when your body doesn't properly absorb this fluid. Defective absorption of cerebrospinal fluid causes normal pressure hydrocephalus, seen most often in older people. In normal pressure hydrocephalus, excess fluid enlarges the ventricles but does not increase pressure on the brain. Normal pressure hydrocephalus may be the result of injury or illness, but in most cases the cause is unknown.

 

Tests and diagnosis 

• Congenital hydrocephalus in an unborn child is diagnosed during a routine prenatal ultrasound, or the condition may be discovered during infancy or early childhood, when the head is regularly measured as part of growth monitoring.
• The evaluation of an older child or an adult who develops signs or symptoms of hydrocephalus begins with a careful medical history and a physical and neurological examination.
• Ultrasound
•  Computerized tomography (CT) or magnetic resonance imaging (MRI) can provide detailed pictures of the brain.

 

Treatments and drugs 

•  The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt.
•  People who have hydrocephalus usually need a shunt system for the rest of their lives, so additional surgeries may be needed to insert longer tubing to match a child's growth. Revisions to the shunt also may be needed if the tubing becomes blocked or infected.
• Another surgical option — ventriculostomy — is sometimes used when there's an obstruction of flow between ventricles.