Hydrocephalus

Aug 3, 2018 in Medicine

Hydrocephalus is a medical disorder, which means an excessive amount of cerebrospinal fluid (CSF) in the hollows of the brain. It was first recognized in ancient Egyptian literature approximately 5000 years ago. The term originates from two Greek words “hydro” and “cephalus”, which mean water and head. In the past, scientists used to call it “water on the brain”. Hakim and Adams were the first, who gave a description of hydrocephalus in 1965 (Bakar & Bakar, 2011).

Hydrocephalus is not a sole disease. In other words, this means that it develops from the issues with normal CSF running within the skull and spinal cord (Bakar & Bakar, 2011). The surplus of fluid can lead to high pressure in the brain. It can also ruin the brain that may result into different types of disabilities such as low intelligence, movement and other complications.

Hydrocephalus is considered to be the most frequent neurological condition existing in medical science. The data manifest that the number of people suffering from hydrocephalus range from 500000 to 1.5 million (including children and adults). Taking into consideration the data from the National Institute of Health, hydrocephalus hits one person in every 500 to 1000 births. These numbers make hydrocephalus even more widespread than Down’s syndrome or deafness. It is the most common reason for children’s brain surgery in the USA (Bakar & Bakar, 2011).

Hydrocephalus has various grounds. In most cases, it is an inherited disease; however, it can arise in older children or even grown-ups. In general, hydrocephalus occurs at any medical circumstances that impede the usual flow of CSF. The surplus of fluid makes the usual hollows in the skull larger. In newborn, the first evidence of hydrocephalus is an abrupt amplification or too fast expansion of the head. This occurs due to the fact that the skull of a baby can easily grow in size. Talking about older children, one can state that their skulls cannot be expanded. That is why they tend to have different symptoms such as vision changes, vomiting and problems with balance.

The actual causes of hydrocephalus are still not clear to scientists; however, experts made conclusion about some of them:

  • Complexities, which have a connection with the premature birth, for instance, intraventricular hemorrhage;
  • Several diseases including meningitis and different head injuries;
  • Tumors.

According to its origin, one can distinguish the two types of hydrocephalus: congenital and acquired. If take congenital hydrocephalus into consideration, it arises at the moment of birth and is considered as the result of elaborate interplay of genetic and environmental facets. However, genetic does not mean inherited. It often happens that no one can diagnose the true cause of the disease. In some cases, hydrocephalus can be diagnosed even before the birth, namely, by means of ultrasound. Nevertheless, this type of hydrocephalus is hard to recognize and diagnose promptly. For instance, a person can have hydrocephalus since birth and being diagnosed only in maturity. In this case, it is applies to compensated hydrocephalus. On the contrary, acquired hydrocephalus deepens after birth, usually as the consequence of neurological circumstances. It can have an effect on people of all age categories and may be the result of brain tumor, intraventricular hemorrhage, head trauma or even infection of the CNS (Pople, 2002).

The main reasons for congenital hydrocephalus include neural tube defects (myelomeningocele), aqueductal obstruction (stenosis), Dandy-Walker syndrome, arachnoid cysts, and Arnold-Chiari malformation. Aqueductal obstruction appears when the long, thin passage between the third and fourth ventricles is blocked, mostly due to infection, tumor or hemorrhage. Arachnoid cysts appear at any place inside the brain. In children, they are situated at the back side of the brain, close to the third ventricle. In the case of Dandy-Walker syndrome, the fourth ventricle is megascopic due to the fact that its passages are slightly or fully closed. As a result, part of the cerebellum does not develop. Arnold-Chiari malformation occurs in the bottom of the brain, where the brain and spinal cord are connected (Pople, 2002).

On the contrary, acquired hydrocephalus can be caused by intraventricular hemorrhage, meningitis, head injury, brain tumors and ventriculitis.

Congenital and acquired hydrocephalus can be characterized as communicating and non-communicating. When after leaving the ventricles there is a blockage in the flow of CSF, communicating hydrocephalus occurs. It is so named because the CSF can flow amidst the ventricles that are open.  Non-communicating hydrocephalus is also called obstructive. It usually appears when there is a blockage in the flow of CSF together with a few slim ways joining the ventricles (Kirkpatrick, Engleman, & Minns, 1989).

The symptoms of hydrocephalus depend on the age of patient and the stadium of the disease. The most common symptoms involve mental deterioration, double vision and derangement. The main complexity is that the symptoms of hydrocephalus are hard to distinguish from the symptoms of other medical conditions. That is why it is highly recommended to consult a doctor in order to avoid serious medical complications (Kirkpatrick, Engleman, & Minns, 1989).

The symptoms of hydrocephalus vary in accordance with the age and patient’s tolerance to CSF. For instance, tolerance to the CSF pressure on newborn is different from that on adult. Newborns usually suffer from the fast growth of the head. Their fontanel is usually stretched and salient, and scalp becomes narrow and shining, making the veins visible. Other symptoms are as follows:

  • Vomiting;
  • Irritability;
  • Sleepiness.

The symptoms of hydrocephalus in adults are different due to the fact that their brain cannot grow in order to cope with the accumulation of CSF. These symptoms involve the following ones:

  • Double vision;
  • Nausea;
  • Headache;
  • Poor coordination;
  • Imbalance;
  • Urinary incontinence. In the early stages, the disease causes the urinary urgency, and only after a while it leads to incontinence (D'abreau, 2004).

There are two options for hydrocephalus that must be treated: shunt placement and third ventriculostomy. The procedure called shunt placement means the surgical disposition of a hydrocephalus shunt system. With the help of this system, the circulation of CSF deflects from a place inside the central nervous system (CNS) to another location within the body where it can be taken up as a component of the circulatory process (Bakar & Bakar, 2011).

Hydrocephalus shunt is known to be a pliable but solid silastic (sort of a silicone rubber) pipe. The hydrocephalus shunt system is made up of a valve, catheter and shunt. One edge of the catheter is situated in the central nervous system. In most cases, it is inside the skull but may be in a cyst or even the spinal cord, as well (D'abreau, 2004). Other edge of the catheter is situated in the stomach, although it can also take place in other parts of the organism such as a hollow in the lungs or a chamber of the heart.

Despite the fact that hydrocephalus shunt is an efficient device, it also has some drawbacks. There can be some complexities of shunt concerning the treatment of hydrocephalus. These are the most common difficulties: infections, occlusion, mechanical failure or the necessity to extend or restore the catheter. In order to avoid such complications, it is advisable to regularly monitor the hydrocephalus shunt system. In cases of complications, the shunt system is required a special type of alteration. Some types of complications can result into other problems concerning under-draining and over-draining. Under-draining appears as a result of the slow removal of CSF. Over-draining happens when the CSF is allowed to drain faster than it is provided (Bakar & Bakar, 2011).

In addition to the usual symptoms of hydrocephalus, infections can also cause fever, inflammation of the neck and shoulder muscles and even redness and tenderness. It is vital to seek for medical observation when some of these symptoms arise.

The second variant to treat hydrocephalus is the third ventriculostomy. It is considered to be an alternative way of treatment. By means of neuroendoscope, doctors are able to visualize the ventricular surface. Neuroendoscope is a little camera, which is designed for the observation of small surgical places that are difficult to access.

All in all, hydrocephalus is a lifelong medical condition, which affects people of all age categories. It has a lot of unpredictable consequences on the human organism. That is why if leave it without treatment, the symptoms will become worse, and, as result, it can lead to serious brain damage or even death.

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