Hydrocephalus can affect adults and children. Dilated cerebral ventricles can affect brain functions in hydrocephalus. Although hydrocephalus cannot be cured, it can be treated.
What is hydrocephalus?
Hydrocephalus is an abnormal enlargement of the fluid-filled fluid spaces (ventricles) of the brain. It is also called hydrocephalus or dropsy. Click to enlarge. The clinical picture of hydrocephalus is also called water head in the vernacular (according to the German translation of the term hydrocephalus). Characteristic of the clinical picture of hydrocephalus are enlargements of the so-called ventricles of the brain; these ventricles are interstitial spaces filled with cerebrospinal fluid. If infants are affected by hydrocephalus, this can visually present itself in an enlarged skull. This is due to the fact that an infant’s skull bones have not yet finally connected and the skull expands due to hydrocephalus. Hydrocephalus can present in various forms in affected individuals. These different forms differ, for example, in terms of the ventricles that are affected by expansion. Medicine also differentiates between various forms of the disease in terms of corresponding causes that lead to hydrocephalus.
Causes
Possible causes of hydrocephalus are diverse. For example, the disease may be caused by the body’s overproduction of cerebrospinal fluid (also known as cerebrospinal fluid). Hydrocephalus can also be caused by an occlusion of the connections that exist between the cerebrospinal fluid spaces in healthy individuals. A distinction is made between congenital and so-called acquired (i.e. not already congenital) causes of hydrocephalus: Congenital causes of hydrocephalus may be due to malformations of the brain or skull bones, among other things. Various developmental disorders of the brain and genetic defects can also lead to hydrocephalus. Acquired causes that can underlie hydrocephalus include injuries to the brain from accidents, inflammation of the brain, or cerebral hemorrhage. Thrombosis of the head or rhesus incompatibility may also be acquired causes of hydrocephalus.
Symptoms, complaints, and signs
Hydrocephalus can first be recognized by the typical, usually balloon-shaped inflation of the head. The top of the skull sometimes appears swollen and may hurt when touched. Hair growth is often also disturbed. The increase in pressure in the skull causes severe headaches, visual disturbances and seizures. Many children suffer severe epileptic seizures in the first days of life, often heralded by sweating, trembling and generally unusual behavior. The severe pain, combined with the disturbance of consciousness, leads to nausea and vomiting. Visual disturbances may be intermittent or persist permanently, with affected individuals seeing double images or having blurred perception of their surroundings. In individual cases, hearing problems develop, even leading to complete deafness of the affected child. In the course of the disease, paralysis and other sensory disturbances may develop in the area of the head and in other regions of the body. In addition, dizziness, gait disturbances and disturbances of consciousness occur. Affected individuals repeatedly lose consciousness or even fall into a coma. If hydrocephalus is not treated early, irreversible damage to the brain inevitably occurs. In severe cases, the disease is fatal.
Diagnosis and course
To diagnose hydrocephalus, so-called imaging procedures are usually used. These methods include, for example, ultrasound examination, computed tomography (CT) examination or magnetic resonance imaging (MRI). Which of these methods is particularly suitable for diagnosing hydrocephalus in an affected person depends, among other things, on the assumed cause of hydrocephalus or the age of a patient: Ultrasound, for example, is particularly suitable for newborns because of the not yet fully closed skullcap. The course of hydrocephalus depends, among other things, on the form of the disease and the therapeutic measures taken. The course of hydrocephalus also varies between individuals.Possible initial symptoms of hydrocephalus include headache or nausea. Severe courses may lead to impaired consciousness or coma. Appropriate therapeutic measures can often lead to significant improvement in symptoms of hydrocephalus (such as gait disturbances or bladder emptying disorders).
Complications
Hydrocephalus causes limitations in brain function. These can have a negative impact on both the physical and psychological state, significantly reducing the patient’s quality of life. The patient’s head is inflated by this disease and appears relatively large. This likewise results in higher pressure in the skull, which can lead to headaches. In many cases, the pain also spreads to other regions of the body and can lead to various complaints there as well. Furthermore, those affected suffer from visual disturbances, whereby veil vision or double vision can also occur. In severe cases, epileptic seizures also occur. As the disease progresses, paralysis and other sensory disturbances occur. The patient’s everyday life is severely restricted by the symptoms. Gait disturbances also occur and it is not uncommon for patients to lose consciousness or fall into a coma. Treatment is by surgical intervention and usually leads to a positive course of the disease. Complications usually occur only if treatment is not received early and irreversible damage to the brain has occurred.
When should you see a doctor?
Because hydrocephalus can negatively affect brain function, this condition must always be treated by a doctor. No self-healing occurs in this process. In most cases, hydrocephalus is diagnosed by a doctor before birth or immediately after birth. Therefore, a further visit for diagnosis is usually not necessary. Furthermore, however, a doctor should always be consulted if the child suffers from severe headaches or vomiting. Further down the line, hydrocephalus can also lead to vision problems, causing patients to suffer from double vision or veil vision. In this case, a medical examination is also highly advisable. The treatment of this disease is usually carried out by different specialists and depends on the exact severity of the complaint. However, a complete cure is not achieved. In many cases, parents or relatives also suffer from severe psychological symptoms, so psychological treatment is advisable.
Treatment and therapy
A commonly used therapeutic procedure for the treatment of hydrocephalus is the implantation of a shunt: A shunt is a thin tube made of plastic and silicone that drains cerebrospinal fluid from the cerebral ventricles to other parts of the body when hydrocephalus is present. For this purpose, the shunt is transferred from an affected brain chamber to the abdominal cavity, for example. The aim of this procedure is to reduce the size of dilated brain ventricles. The laying of the tube to alleviate the symptoms of hydrocephalus is performed under the skin; the procedure performed is therefore not visible from the outside. Shunts can be used to treat hydrocephalus in both adults and children. Depending on their form, implanted tubes used to treat hydrocephalus can have different valves: For example, these valves respond to high or low pressure from the cerebral ventricles. One therapy for specifically lowering the third ventricle of the brain is called endoscopic third ventriculostomy (ETV); here, a minimal hole is made in the ventricular wall. Drug therapies to treat hydrocephalus are generally used infrequently and in the short term.
Outlook and prognosis
After surgical intervention, a positive course of the disease is usually established. Early diagnosis favors this. It is crucial that there is no lasting damage to the brain. A basic distinction must be made between prognoses for newborns and infants and those for adults. Hydrocephalus is not curable; however, it can be successfully treated in most cases. Thus, according to the current state of medical possibilities, there is a positive outlook for sufferers. Children in particular can usually lead a life without further complaints if treated in time. Studies prove the success of the shunt.Two-thirds of them are able to follow the same educational path as healthy peers. About every tenth child dies. In the others, behavioral problems remain that result from the restrictions on brain function. These can be minimized by means of tutoring and special therapies. The prospects for adults are not clear. For them, it depends on how they came to have the disorder. They do not always have to wear a shunt for life. A conspicuously large number of seniors develop hydrocephalus. In them, increased age results in an increased risk after surgery.
Prevention
It is almost impossible to prevent hydrocephalus. However, it can positively influence the course of the disease if an existing hydrocephalus is diagnosed early and can be treated medically accordingly. The extent of secondary damage due to the dilated brain chambers in hydrocephalus can be reduced in this way in many cases.
Follow-up
Proper follow-up care is of great importance even in such a low-risk operation as shunt surgery. In particular, insofar as a ventriculo-peritoneal diversion is involved, the patient must maintain food abstinence on the day of surgery. Already one day after the operation, patients are mobilized by physiotherapy and are allowed to eat and drink normally. After a few days, the position of the brain catheter and the width of the cerebral ventricles are checked by means of a computer tomographic examination. This serves to confirm that the procedure has been successfully performed and is providing the patient with the desired relief. The patient can then leave the hospital and return to everyday life. Annual follow-up examinations by means of CT scans and discussion of existing symptoms are essential. They reveal possible postoperative complications such as subdural hemorrhage due to overdrainage and allow rapid treatment if necessary. Patients who have experienced such overdrainage on one occasion can discuss with their treating physician the possibility of implanting postoperative adjustable gravitational valves, which are then used in the next needed operation. Shunt insufficiencies due to an obstructed catheter are also possible and require prompt correction.
Here’s what you can do yourself
Medical therapy is indicated in all cases to treat hydrocephalus. The individual symptoms can be alleviated by those affected through a number of self-help measures. Epileptic seizures can be reduced by preventive measures, for example, avoiding possible triggers and using an emergency medication helps to prevent seizures. Bed rest and sparing help against nausea, vomiting and headaches. In addition, the affected person should adjust his or her lifestyle to avoid any accompanying symptoms. If double vision occurs, medical advice is required. The first acute measure here is also rest and relaxation. In principle, hydrocephalus must be treated surgically. After surgery, a recovery period of several weeks is indicated. The patient should make an effort to have regular check-ups by the doctor even after the treatment has been completed. If complications arise, it is best to go to the hospital immediately. Since hydrocephalus always places an emotional burden on those affected, therapeutic counseling is advisable. Participation in a support group can also help sufferers accept the external blemishes and any discomfort.
