Hydrocephalus in children and adults. Causes, symptoms, treatment

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Hydrocephalus is a health and life-threatening condition that is associated with an excessive accumulation of cerebrospinal fluid in the ventricular system of the brain. Hydrocephalus usually occurs in infants and young children, but it can also affect adults, causing serious problems with the functioning of the entire body. How is hydrocephalus manifested and what are its causes? What is the treatment of hydrocephalus?

Hydrocephalus – what is it and how is it formed?

Hydrocephalus, also called hydrocephalus or hydrocephaly – from Latin. hydrocephalus (from the Greek words “hydro” – water and “kephale” – head) – is defined as a state in which there is an imbalance in the amount of cerebrospinal fluid.

This fluid, when all is well, is produced in the choroid plexuses of the brain’s ventricles – usually about 0,5 liters per day. Then it circulates within the cerebral ventricles, and also travels to the subarachnoid space of the brain and the spinal cord, supplying nerve cells with nutrients.

The cerebrospinal fluid is also designed to protect the brain against possible mechanical factors and maintain the correct intracranial pressure. It is also responsible for the metabolism of nutrients. When all these tasks are fulfilled, it enters the circulatory system and is absorbed there into the blood, and another dose of fluid is produced in the choroid plexuses.

In pathological situations, when the balance between fluid production and its absorption in the circulatory system is disturbed or if there is some obstacle disturbing its circulation, the cerebrospinal fluid begins to accumulate in the ventricles of the brain. This process results in the development of hydrocephalus that is very dangerous to health.

Hydrocephalus – causes

Hydrocephalus can have very different origins. The disease can develop at virtually any age, from fetal life to old age, and has a complex pathogenesis.

Among the most common causes of hydrocephalus, the following are usually indicated:

1. congenital hydrocephalus – its development is not entirely clear, although it may be responsible for e.g. stenosis of the brain’s water supply (too narrow connection between consecutive cerebral ventricles), neural tube defects, cerebrospinal hernia, Arnold-Chiari malformation, Dandy-Walker syndrome or arachnoid cysts;
2. intracranial hemorrhages – blood clotting may permanently or temporarily prevent the free flow of cerebrospinal fluid;
3. meningitis, especially purulent – as a result of infection of the brain mucosa, swelling appears, blocking the outflow of fluid;
4. developing tumors and brain tumors – as they grow in size, they press with increasing force on the brain tissue, which makes the outflow of the cerebrospinal fluid much more difficult;
5. genetic defects – although this is the rarest cause of hydrocephalus development.

Also read: Brain tumors – symptoms, diagnosis, modern therapy

Hydrocephalus – types of hydrocephalus

Due to the genesis of the disease, hydrocephalus can be defined as communicating or non-communicating (obstructive), and both types may be acquired or congenital.

Communicating hydrocephalus is associated with disorders of cerebrospinal fluid reabsorption, which are not related to the appearance of an obstacle blocking its flow in the ventricular system. This type usually appears after infection or other neurological conditions.

Non-communicating hydrocephalus (or obstructive), on the other hand, is related to the appearance of an obstacle – obstruction – in the circulation of the cerebrospinal fluid. It is usually the result of congenital malformations or acquired diseases and conditions, such as cancer or a brain tumor.

There are also other specific types of hydrocephalus with specific characteristics, such as:

1. Normotensive hydrocephalus. This is a specific type of communicating hydrocephalus – it is an enlargement of the ventricles of the brain, but without a significant increase in the pressure of the cerebrospinal fluid. It is usually associated with a change in the flexibility of the ventricles and an increase in the viscosity of the cerebrospinal fluid. Normotensive hydrocephalus is difficult to detect – in order to diagnose it, it is necessary to continuously measure the fluid pressure for at least 24 hours.
2. Hydrocephalus ex vacuo (“from nothing”). With this disease, the ventricular system widens secondary to the atrophy of the brain parenchyma. Unlike other types of hydrocephalus, ex vacuo hydrocephalus is associated only with compensatory enlargement of the ventricles of the brain and is not caused by an increase in cerebrospinal fluid pressure. This type of hydrocephalus can result from brain atrophy (e.g. related to dementia) or traumatic brain injury, but it can also result from certain psychiatric disorders, e.g. from schizophrenia.
3. Auricular hydrocephalus. This is a very rare complication of acute otitis media.

Hydrocephalus in infants – symptoms

Hydrocephalus in newborns and infants, due to their still not fully formed anatomical structure and other underlying disease, manifests itself differently than hydrocephalus in adults and older children. The skull bones in toddlers are not closely related – so hydrocephalus in infants will cause:

1. enlargement of the head circumference;
2. tension and prominence of the parietal;
3. widening of the joints of the skull;
4. widening of the scalp veins;
5. Parinaud’s Syndrome – your eyes are constantly looking down, even when you look up (also known as “sunset symptom”);
6. annoyance.

Importantly, hydrocephalus can be diagnosed in the womb of a child: during an ultrasound scan in the 20th week of pregnancy. That is why regular visits to the gynecologist are so important during pregnancy. Hydrocephalus is associated with 9 out of 10 cases of meningeal hernia.

After childbirth, it is important to constantly monitor the baby for the possibility of hydrocephalus. The symptoms of hydrocephalus can appear at any stage of infancy. In order to be able to detect this disease quickly and efficiently, a number of measurements are made, such as regular measurement of the circumference of the infant’s head, the width of the skull sutures and the tension of the crown. The psychomotor development of the child is also monitored.

Also read: Diseases detected in the womb – diagnosis and prenatal examinations indicated

Hydrocephalus in children – symptoms

In older children, in whom the skull is already formed, symptoms that are harbinger of hydrocephalus include:

1. vomiting;
2. severe headaches;
3. excessive sleepiness;
4. changes in the appearance of the face, as well as in personality, character, behavior, etc .;
5. convergent strabismus;
6. problems with coordination of movement and walking, and limited mobility;
7. slow growth.

Hydrocephalus in adults – symptoms

Hydrocephalus in adults is much more difficult to detect – the symptoms do not clearly indicate this disease. Its heralds, associated with an increase in intracranial pressure, may be headaches, vomiting, nausea, choking disc, somnolence or even coma.

In the case of normotensive hydrocephalus, it is referred to as the so-called Hakim’s triad of symptomswhich include:

1. stupor;
2. ataxia;
3. urinary incontinence.

It is often accompanied by other specific neurological symptoms, especially palsy of the abduction nerve or the already mentioned Parinaud’s syndrome.

Find out more: What is the sunset symptom?

Hydrocephalus – valve and other treatments

How is hydrocephalus treated? Usually it turns out necessary surgery. To allow the outflow of excess cerebrospinal fluid, a ventricular peritoneal valve can be implanted into the ventricular system, or rather a special catheter with a system of silicone tubes with such a valve.

It redirects excess fluid into the peritoneal cavity or into the bloodstream. There are various models of such a valve – the correct type is selected by the neurosurgeon depending on the patient’s needs.

It is also possible to regulate the circulation of the cerebrospinal fluid in other ways. Sometimes a procedure is performed endoscopic ventriculostomy of the third ventricle of the brain. What does it mean? Endoscopic technique is used to make an opening (stoma) in the bottom of the third cerebral ventricle, which creates an outlet path for the cerebrospinal fluid. This is a fairly effective treatment for patients with non-communicating hydrocephalus.

When hydrocephalus is caused by another disease, such as meningitis or a brain tumor, treating the underlying disease usually heals the hydrocephalus at the same time.

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