What is Hydrocephalus

Information on Hydrocephalus

Hydrocephalus is the neurological disorder occurring when cerebrospinal fluid (CSF) gets abnormally accumulated in the ventricles and subarachnoid space of the brain. Overproduction of CSF ('choroid plexus papilloma') causing increase in the intercranial volume, obstruction of the flow of CSF, or inability of brain structures to absorb the fluid results in the increase of intercranial pressure (ICP). It mostly affects children, but sometimes target adults and the old.

CLASSIFICATION

1. Non-communicating or obstructive hydrocephalus - occurs due to communication gap between the ventricular system and the subarachnoid space; the reason being aqueduct blockage.
2. Communicating or non-obstructive hydrocephalus - occurs due to communication between the ventricular system and the subarachnoid space; the reason being post-infective and post-haemorrhagic hydrocephalus.
3. Congenital hydrocephalus - Mostly targets newborns; in this  the head circumference gets enlarged,
   since the skull bones are in their developmental stage so they are not intact and strong. Initial and most important symptom being a bulging and firm fontanelle (soft spot).
4. Acquired hydrocephalus - As the name refers, this is an acquired condition due to CNS-infections, brain tumors, trauma and intracranial hemorrhage.

Causes of Hydrocephalus

CSF flow obstruction and overproduction of cerebrospinal fluid is the common cause of Hydrocephalus.

• Over secretion of Cerebrospinal Fluid (CSF) - choroid plexus papilloma or carcinoma
• Obstruction to CSF circulation - can occur in colloid cyst and tumors of third ventricle; also in suprasellar arachnoid cyst or hypothalamic tumors; in addition to subarachnoid spaces following meningitis or haemorrhage in these areas - causing blockage.
• Obstructive Hydrocephalus
  • Blockage of Aqueduct - i.e. Congenital Aqueduct Stenosis; leads to the dilated  ventricles and large head of the affected children.
  • Posterior Fossa Tumors occurs due to blockage of the 4th ventricle. Other reasons being Medulloblastoma, cystic astrocytoma and ependymoma
  • Dandy Walker Syndrome - i.e. blockage of foramina of the 4th ventricle (congenital condition).
• Insufficient secretion of CSF into the venous sinuses due to scarring of the arachnoid villi; usually following meningitis or haemorrhage.

Signs and Symptoms of Hydrocephalus

In infants, common symptoms of Hydrocephalus are given below -
1) Vomiting
2) Irritability
3) Slow Development
4) Sleepiness
5) Seizures
6) Anterior fontanel
7) A rapid increase in the size of the head
8) An unusually large head
9) A bulging "soft spot" on the top of the head

In older children and adults , symptoms include Irritability, memory loss, headache with vomiting, nausea, double vision and urinary incontinence.

Treatment of Hydrocephalus

Only surgery is the way of treatment of hydrocephalus. Surgery includes the placement of a ventricular catheter into the cerebral ventricles. It bypasses the flow obstruction arachnoidal granulations and drains the extra fluids into other body cavities from where it can be reabsorbed. Endoscopic third venstriculostomy is an alternative treatment. Third venstriculostomy an alternative therapeutic option to traditional CSF.