Hydrocephalus
Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles of the brain. The ventricles are fluid-filled cavities deep inside the brain. Hydrocephalus is caused by a mismatch of CSF production and absorption. This, in turn, causes an increase in pressure within the brain.
What’s in this section?
Signs and Symptoms
The signs and symptoms of hydrocephalus vary by age group.
For young to middle-aged adults, common symptoms include the following:
- Headache
- Lethargy
- Difficulty with coordination or balance
- Urinary incontinence or urination urgency
- Issues with vision
- Memory or concentration problems
For older adults (~60 and older), common symptoms include the following:
- Urinary incontinence or urination urgency
- Memory loss
- Difficulty with cognitive functioning
- Trouble walking
- Difficulty with coordination or balance
Potential Causes
The causes of hydrocephalus may or may not be known. In younger (newborn) patients, hydrocephalus can be caused by an abnormally developed central nervous system, bleeding within the ventricles or infections which cause brain tissue to swell. Hydrocephalus may be found following trauma to the brain, as well as in those experiencing stroke, tumor or central nervous system infection.
Diagnosis
Diagnosis of hydrocephalus starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose, including:
- Detailed neurological exam This is an assessment of the body’s nervous system, including neurons and motor responses such as reflexes.
- Magnetic resonance imaging ( MRI ) scan uses powerful magnets to create detailed pictures of internal body tissues, including the brain.
- Head CT is an x-ray that shows the inside of the brain from different angles.
Treatment Options
There are two commonly used treatment options for hydrocephalus:
- Shunting A shunt is used to drain the extra CSF from the ventricles in the brain into the abdominal area or right atrium of the heart—in order to relieve pressure on the brain.
There are many ways to put in a shunt. A VP shunt goes from your head to your belly. The surgeon will create a hole and put a small tube or catheter into the brain, sometimes using a special type of X-ray. The tubing is then connected to a longer piece which is placed in the belly through a small incision(s). A valve sits between these two tubes to direct and control flow; some valves can be sped up or slowed down in the office with a special magnet. A VA shunt is like a VP shunt, but the final catheter is placed in the heart instead of the belly. An LP shunt puts the first catheter into an area in your spine (back) and the rest into your belly. There are other places the end of the shunt can be placed as well. All of these allow fluid to drain and be absorbed properly. - Percutaneous Ventriculostomy A temporary shunt used in emergencies to relieve pressure from hydrocephalus. The procedure or surgery can be performed in the operating room, at bedside in the ICU and also at bedside in the emergency room. Patients are usually very sick when this procedure needs to occur, and they typically already have a breathing tube in place. The surgeon will create a hole and put a small tube or catheter into the brain. Occasionally this can improve someone in a deep coma to an improved state of consciousness. The ventriculostomy allows the neurosurgeon and other doctors and nurses to monitor the pressure in your brain
- Endoscopic third ventriculostomy Another procedure for the treatment of hydrocephalus is an endoscopic third ventriculostomy (ETV), with or without cauterization of the choroid plexus, the substance in the ventricles that secretes the CSF. An ETV allows CSF to bypass the obstruction causing the hydrocephalus and circulate from the ventricles to the space surrounding the brain so that it can be reabsorbed back into the vascular system.
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