Hydrocephalus or water on the brain
}1 July, 2021
jDr. Muhannad Al-Khatib

Hydrocephalus or water on the brain

Hydrocephalus, what it is, its types, symptoms, causes, treatment methods in Turkey, and common questions about it.

Hydrocephalus or water on the brain

Hydrocephalus, what it is, its types, symptoms, causes, treatment methods in Turkey, and common questions about it.

Table of Contents

    Hydrocephalus, what it is, its types, symptoms, causes, treatment methods in Turkey, and common questions about it.

    Hydrocephalus, also called water on the brain or hydrocephalus, is a condition in which there is an abnormal buildup of CSF (cerebrospinal fluid) in the cavities (ventricles) in the brain. The buildup is often caused by a blockage that prevents fluid from draining properly.

    What is hydrocephalus?

    In hydrocephalus, a buildup of cerebrospinal fluid can raise pressure within the skull, compressing and damaging surrounding brain tissue.

    In some cases, this can cause excessive head growth, convulsions, and brain damage. Hydrocephalus can be fatal if left untreated.

    Other symptoms include headache, vomiting, blurred vision, cognitive problems, and walking difficulties.

    The outlook for a patient (prognosis) with hydrocephalus depends primarily on how quickly the condition is diagnosed and treated, and whether there are any underlying disorders.

    But the term "water in the brain" is incorrect, because the brain is surrounded by CSF (cerebrospinal fluid), not water.

    This CSF fluid has several vital functions, namely:

    • Nervous system protection
    • nourishes the brain

    The brain produces about a pint of cerebrospinal fluid each day, and the old cerebrospinal fluid is absorbed by the blood vessels. If the production and removal of cerebrospinal fluid is disrupted, cerebrospinal fluid can build up, causing hydrocephalus.

    Types of hydrocephaly

    There are a number of types of hydrocephalus:

    congenital hydrocephalus

    About 1 in 500 American children are born with hydrocephalus (water on the brain). It may be caused by an infection in the mother during pregnancy, such as German measles or mumps, or a birth defect, such as spina bifida.
    It is one of the most common developmental disabilities, more common than Down syndrome or deafness.

    Acquired hydrocephalus

    This occurs after birth, usually after a stroke, a brain tumor, meningitis, or a serious head injury.

    Connective hydrocephalus

    This type of hydrocephalus occurs when the pathway of cerebrospinal fluid is blocked after leaving the ventricles. It is called "connected" because cerebrospinal fluid can still flow between the ventricles of the brain.

    Non-contact hydrocephalus

    Also called obstructive hydrocephalus, non-communicating hydrocephalus occurs when the tiny connections between the ventricles become blocked.

    Normal pressure hydrocephalus

    This only affects people 50 years of age or older. It may develop after a stroke, injury, infection, surgery, or bleeding. However, in many cases, doctors do not know why it occurs. It is estimated that 375,000 older adults in America suffer from normal hydrocephalus.

    Compensatory hydrocephalus (due to voiding)

    This type occurs after a stroke, traumatic brain injury, or degenerative disease. As brain tissue shrinks, the ventricles of the brain become larger.

    Hydrocephalus Symptoms

    Symptoms of congenital hydrocephalus (present at birth):

    • breathing difficulties
    • Arm and leg muscles may be stiff
    • Some growth stages, such as sitting or crawling, may be delayed
    • The fontanelle, the soft spot on the top of the head, may be shrinking and bulging outward
    • Irritability, drowsiness, or both
    • Unwillingness to bend or move the neck or head
    • poor nutrition
    • The head looks too big
    • The scalp is thin and shiny and there may be visible veins on the scalp
    • The pupil of the eye may be close to the bottom of the eyelid, sometimes known as "sunset"
    • There may be a high-pitched cry at birth
    • vomiting

     

    Symptoms of acquired hydrocephalus, which appear after birth, are:

    • Intestinal incontinence
    • drowsiness and lethargy
    • headache
    • irritability
    • lack of appetite
    • nausea
    • personality changes
    • Vision problems, such as blurred or double vision
    • incontinence
    • vomiting
    • Difficulty walking, especially in adults

     

    Symptoms of normal pressure hydrocephalus:

    Signs and symptoms may take several months or years to appear.

    • Changes in the way you walk: A person may feel as if they are frozen when they take their first step to start walking.
    • The normal thinking process is slowed: a person may respond to questions more slowly than usual, and reactions to situations may be delayed. The individual's ability to process information is slowed down.
    • Urinary incontinence: This usually occurs after changes in the way you walk.

    Risk factors for hydrocephalus

    The following factors increase the risk of developing hydrocephalus:

    • Premature birth: Babies born prematurely have a higher risk of bleeding into the ventricles of the brain, which can lead to hydrocephalus.
    • Problems during pregnancy: Infection in the uterus during pregnancy increases the risk of dropsy in the fetus.
    • Problems with fetal development: an example is incomplete closure of the spine.

    Other conditions that increase the risk of hydrocephalus include:

    • Lesion and tumors of the brain or/and spinal cord
    • nervous system infections
    • cerebral hemorrhage
    • severe head injury

    Causes of hydrocephalus

    Hydrocephalus occurs when too much fluid builds up in the brain. Specifically, excess cerebrospinal fluid (cerebrospinal fluid) accumulates in the cavities (ventricles) of the brain.

    There are more than 100 possible causes of hydrocephalus, but the main group of causes is:

    • Producing too much cerebrospinal fluid.
    • One of the brain's ventricles is blocked or narrowed, stopping or restricting the flow of cerebrospinal fluid, so that it cannot leave the brain.
    • When cerebrospinal fluid cannot filter into the bloodstream.

    Causes of congenital hydrocephalus (present at birth)

    • A baby is born with a blockage of the cerebral canal, a long passage in the midbrain that connects the two large ventricles. This is the most common reason.
    • The choroid plexus secretes a lot of cerebrospinal fluid.
    • Health conditions or birth defects in a developing baby can cause problems with how the brain develops. For example, hydrocephalus is common in children with severe spina bifida (a birth defect of the spinal cord).

    Infection during pregnancy - it can affect the baby's brain development. Examples include:

    • CMV (cytomegalovirus)
    • German measles (German measles)
    • mumps
    • Syphilis
    • Toxoplasmosis

    Causes of acquired hydrocephalus

    This condition develops after birth and is usually caused by an injury or disease that causes a blockage between the ventricles. The reasons may be the following:

    • Brain hemorrhage.
    • Brain lesions - There are many possible causes, including injury, infection, exposure to certain chemicals, or problems with the immune system.
    • Brain tumors - benign (non-cancerous) or malignant (cancerous) tumors in the brain.
    • Meningitis - inflammation of the membranes surrounding the brain or spinal cord.
    • Stroke - a condition in which a blood clot or a ruptured artery or blood vessel cuts off blood flow to an area of the brain.

    Causes of normal pressure hydrocephalus

    This condition affects people as young as 50 years old — in most cases, doctors don't know what's causing it. Sometimes, it may develop after a stroke, infection, or brain injury.

    There are two theories:

    • Cerebrospinal fluid is not absorbed into the bloodstream properly. Because of this, the brain begins to produce less new cerebrospinal fluid, which leads to a gradual rise in pressure over a long period. A gradual rise in pressure may lead to progressive brain damage.
    • Having an underlying condition, such as heart disease, high cholesterol, or diabetes, which may soften brain tissue. Softening of brain tissue increases pressure.

     

    Hydrocephalus Diagnosis

    Infants and young children (congenital hydrocephalus):

    A routine prenatal ultrasound may detect hydrocephalus during pregnancy in the developing fetus.

    After birth, the baby's head is measured regularly. Any abnormalities in head size will likely lead to further diagnostic testing.

    If the ultrasound shows an abnormality, more tests will be ordered, such as an MRI or computerized tomography (CT) scan, which gives more detailed images of the brain.

    Acquired hydrocephalus (occurs after birth) - if a child or adult has signs and symptoms of hydrocephalus, the doctor will:

    • Examination of the patient's medical history.
    • Perform a physical and neurological examination.
    • Order an imaging test, such as a computerized tomography (CT) scan or an MRI.

    Normal pressure hydrocephalus - This type of hydrocephalus is more difficult to diagnose because the symptoms are more subtle and do not appear suddenly.

    Hydrocephalus treatment in Turkey

    In this section, we will discuss the treatments for congenital and acquired hydrocephalus and the treatments for normal pressure hydrocephalus.

    Treatments of congenital and acquired hydrocephalus in Turkey:

    Both types of hydrocephalus require urgent treatment to reduce pressure on the brain. Otherwise, there is a high risk of damage to the brain stem, which regulates functions such as breathing and heartbeat.

    A drainage system called a shunt is surgically performed. A catheter (a thin tube with a valve) is placed in the brain to drain excess water from the brain to another part of the body, such as the abdomen, chest cavity or heart chamber. Usually, this is all that is needed, and no further treatment is needed.

    Patients with hydrocephalus usually need a shunt system that is fixed in place for the rest of their lives. If the shunt is placed in a child, additional surgeries may be needed to insert longer tubes as they grow.

    Ventricular puncture - the surgeon makes a hole in the lower part of the ventricle so that excess fluid flows toward the base of the brain. Normal absorption occurs at the base of the brain. This procedure is sometimes performed when the flow of fluid between the ventricles is obstructed.

    Natural pressure hydrocephalus treatment in Turkey

    Shunts may also be used for normal pressure hydrocephalus. However, shunts may not be appropriate for some patients. Other procedures can be performed to check suitability:

    Lumbar puncture - some of the cerebrospinal fluid is removed from the base of the spine. If this improves the patient's gait or mental abilities, a shunt installation will likely help.

    Lumbar leak test - a needle is inserted through the skin of the lower back into the spine. Cerebrospinal fluid pressure measurements are taken after the fluid is injected into the spine. Patients usually benefit from having a shunt fitted if their cerebrospinal fluid pressure is above a certain limit.

    Ascites complications

    The severity of hydrocephalus depends on several factors, including when and how it develops. If the condition develops when the baby is born, there is likely to be brain damage and physical disabilities. If cases are not severe and treatment is adequate and prompt, the outlook is much better.

    Children with congenital hydrocephalus may have permanent brain damage, which can lead to long-term complications. Examples include:

    • learning difficulties
    • Coordination problems
    • memory problems
    • Speech problems
    • vision problems

     

    Prevention of dropsy

    Pregnancy - Regular prenatal care can significantly reduce the risk of having a premature baby, thus reducing the risk of the baby developing hydrocephalus.

    Infectious diseases - make sure you have all your vaccinations and attend all the tests recommended for you.

    Meningitis Vaccine - Meningitis has been a common cause of hydrocephalus. Vaccination is recommended for some individuals, consult a doctor.

     

    Preventing head injuries

    • Wear your seat belt every time you drive or ride in your vehicle as a passenger.
    • Make sure the children's belts are fastened.
    • Never drive while under the influence of alcohol.

    Helmets or protective headgear should always be worn when:

    • Batting in baseball/softball or cricket.
    • Doing sports that require physical contact.
    • Riding on a horse, motorcycle, bicycle, snowmobile, scooter or all-terrain vehicle (both riders and passengers).
    • Snowboarding, snowboarding, or snowboarding.

    Living areas for seniors:

    • Grab bars should be installed next to the bathtub, shower and/or toilet.
    • Older adults should maintain physical activity to ensure low body strength and balance (reduce the risk of falls).
    • Make sure the lighting in the house is bright enough.
    • Use non-slip mats on bathtub and shower floors.
    • Remove rugs and other things that might cause tripping.
    • Stairs should ideally have handrails on both sides.

    Living areas for children:

    • Install window guards.
    • Place safety gates at the bottom and top of stairs if children are small.

    Children's play areas:

    The floor surface of a child's playground should be made of hardwood sawdust, sand or some other shock-absorbing material.

    Frequently asked questions about hydrocephalus in Turkey

    What is hydrocephalus in children and what is its treatment?

    According to study Speaking of the current trends of hydrocephalus, hydrocephalus is a clinical condition caused by an imbalance between the production and absorption of cerebrospinal fluid (CSF). This imbalance leads to dilation of the cerebral ventricles and an increase in intracranial pressure (ICP). It is more common in children. Technological advances in neuroradiology and neurosurgery have led to early diagnosis and treatment. Treatment involves inserting a shunt device that diverts the excess cerebrospinal fluid into another body cavity. Regardless of the etiology, hydrocephalus is a chronic disease that requires frequent medical and nursing participation.

    Is hydrocephalus dangerous?

    Early detection and treatment and the cause of ascites remain the primary determinant of prognosis.

    Is hydrocephalus dangerous in adults?

    Adults usually develop normotensive ascites, if left untreated, which can be fatal and cause significant disabling. On the other hand, it appears Studies Promising Long-Term Results of Treatment After 6-month follow-up examination, 83% of patients who underwent surgery had improved gait, 65% improved reaction speed, and 46% improved memory, 96% found themselves self-improved. More patients (64%) improved if they were less than 75 years old; For patients over 75 years of age, only 11% of patients improved. Patients with normal pressure hydrocephalus have benefited from shunt surgery for at least 5 years.

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