Hydrocephalus, often referred to as ‘water in the brain’ is an abnormal condition due to excessive accumulation of Cerebral Spinal Fluid within the brain’s cavities.
Hydrocephalus, often referred to as ‘water in the brain’ is an abnormal condition due to excessive accumulation of Cerebral Spinal Fluid (CSF) within the brain’s cavities. These cavities, called ventricles, are normally filled with CSF. When there is excess accumulation or insufficient absorption, hydrocephalus occurs. It can also occur due to obstruction (either because of blood or tumours) in the path of CSF.
Who is affected?
All age groups are affected, from newborns to the elderly. The causes, however,
may vary.
Hydrocephalus can be congenital, meaning the problem is present at birth or acquired. Congenital hydrocephalus generally occurs in children and acquired hydrocephalus can affect both adults and children.
What are the causes?
Congenital causes and associated conditions include Aqueductal Stenosis (narrowing) of the passage between the third and fourth ventricle, improper development of absorptive mechanism, spina bifida, arachnoid cysts, Dandy-Walker malformation, wherein, a portion of the cerebellum fails to develop.
Acquired causes include tumours that block the normal flow of CSF or secrete an abnormal quantity of CSF, meningitis that can scar the delicate membranes that line the CSF path or head trauma that affects premature infants and hypertensive adults.
What are the symptoms?
In infants, it could be enlargement of the head, full and tense fontanel (soft area on top of a baby’s head), stretched and thin scalp with prominent veins, refusal to accept feeds, downward deviation of the eyes and seizures. Adults may have impaired/double vision, personality change, drowsiness, dementia, incontinence of urine.
How is it diagnosed?
Computerised Tomography (CT scan) is often sufficient to make a diagnosis of hydrocephalus. Magnetic Resonance Imaging (MRI) is useful in delineating the ventricle in three different planes.
Ultrasonography is useful in the case of children as a screening tool.
What is the treatment?
Hydrocephalus often responds well to a surgical procedure, in which a flexible tube called ‘shunt’ is placed within the ventricle. The shunt tube diverts the flow of CSF from the ventricles to another region of the body such as the abdomen. Removal of a tumour can re-establish the CSF flow and relieve the hydrocephalus.
Endoscopic Third Ventriculostomy is a modern procedure wherein a perforation is made in the ventricular floor to reestablish the CSF pathway. With this the placement of a shunt tube can be avoided.
Medication alone is often insufficient to treat hydrocephalus.
What does the doctor say?
Examining suspected patients on time can result in early diagnosis and successful treatment.
Among the elderly, failure of memory should not be neglected. Surgically treatable causes of memory loss can then be picked up at an early stage.
Treatment often depends on the cause and involves neurosurgical intervention.
As a child grows it is important to measure the circumference of its head periodically for detecting any abnormal enlargement.
Dr Shailesh AV Rao, MCh (Neurosurgery), DNB (Neurosurgery), senior consultant, neurosurgeon, BGS Global Hospital
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