Hydrocephalus a.k.a. “Water on the Brain”

What is hydrocephalus?

Hydrocephalus is a rare condition in which there is a build-up of fluid in the brain cavities (ventricles). This fluid normally flows through the ventricles and bathes the brain and spinal column to keep the brain buoyant, cushions the brain to prevent injury, removes waste products of the brain’s metabolism, and maintains constant pressure within the brain. However, in hydrocephalus, the extra fluid enlarges the head and puts extra pressure on the brain, causing all kinds of problems and ultimately, brain damage. Hydrocephalus is most common in infants and older adults.

What causes hydrocephalus?

The root of hydrocephalus is an imbalance between how much cerebrospinal fluid is produced and how much is absorbed into the bloodstream, causing excess of this fluid to build up. This excess fluid occurs for one of the following reasons:

• Obstruction to the normal flow of cerebrospinal fluid such as tumors
• Poor absorption, usually related to inflammation of brain tissues from disease or injury, such as central nervous system infections, rubella, stroke, etc.
• Overproduction from the mechanisms that make this fluid

What are the symptoms of hydrocephalus?

The signs and symptoms of hydrocephalus vary by the age of onset in each particular case. In infants and young children, common signs and symptoms include the following:

• Unusually large head or rapid increase in the size of the head
• A bulging or tense soft spot on the top of the head
• Vomiting
• Sleepiness or irritability
• Seizures
• Eyes fixed downward (sunsetting of the eyes)
• Deficits in muscle tone, poor coordination, failure to thrive

In adults, common signs and symptoms are a little bit different. They include:

• Loss of bladder control
• Memory loss
• Difficulty walking, loss of coordination or balance
• Progressive loss of thinking or reasoning skills
• Impaired vision

How is hydrocephalus diagnosed?

Hydrocephalus is diagnosed using a physical and neurological examination, inquiry into signs and symptoms, and brain imaging tests. The examination may aim to evaluate muscle condition, sensory status, movement status, and general psychiatric condition. The brain imaging tests can show the enlargement of the ventricles that is characteristic of hydrocephalus. These tests may include an ultrasound, a MRI Scan, or a CT scan.

What are the available treatments for hydrocephalus?

There are two different surgical treatments that can be used to treat hydrocephalus. The most common treatment for hydrocephalus is a shunt insertion, which is a long, flexible tube with a valve that helps drain fluid from the brain in the right direction and at the correct rate. This shunt system usually needs to be maintained for the patient’s entire life. Patients can also opt for an endoscopic third ventriculostomy surgery, in which the surgeon uses a small video camera to have direct vision inside of the brain and then makes a hole in the bottom of one of the ventricles or between the ventricles to help the flow of cerebrospinal fluid. In addition to these, occupational and developmental therapists, social workers, and special education teachers can also help with any long-term complications of the disease.

Where can I find more information on hydrocephalus?

• Mayo Clinic
• National Institute of Neurological Disorders and Stroke
• Medline Plus