What is hydrocephalus? What are the symptoms and treatment methods?
Hydrocephalus is a combination of the words hydro=water and cephali=head. It is often described as a buildup of fluid in the brain. The water indicated is the cerebrospinal fluid. Cerebrospinal fluid is made and reabsorbed continuously throughout the day, surrounds the brain and spinal cord, and has a continuous circulation. It has three main functions: to reduce the harmful effects of blows to the brain and spinal cord, to help feed the brain and to transport wastes, and to regulate pressure changes in the brain by circulating between the brain and spinal cord.
WHAT IS HYDROCEPHALUS?
hydrocephalus; It occurs as a result of a disturbance between the production and absorption of cerebrospinal fluid. It may occur as a result of a blockage in the cerebrospinal fluid circulation, malabsorption or, rarely, overproduction. The occurrence of hydrocephalus depends on the underlying cause, how long it develops, and compensatory mechanisms.
Hydrocephalus, which develops in infancy before the skull joints are closed, is observed with a marked increase in head circumference. The enlargement of the skull reduces the intracranial pressure somewhat. The intracranial pressure force is distributed over a wider area in the enlarged cerebral waterways, and accordingly, the brain parenchyma is exposed to less pressure. If hydrocephalus occurs suddenly or after the skull joints are closed, there will be a marked increase in intracranial pressure and sudden damage to the brain tissue, as the skull cannot expand.
WHAT ARE THE CAUSES OF HYDROCEPHALUS?
Hydrocephalus results from a disturbance between the production and absorption of cerebrospinal fluid. It may occur as a result of a blockage in the cerebrospinal fluid circulation, malabsorption or, rarely, overproduction.
Hydrocephalus is congenital or may occur later in life for other reasons. Congenital hydrocephalus may be genetic or occur during pregnancy. The causes of hydrocephalus are;
– Congenital Hydrocephalus; These patients constitute the largest group. It may only be hydrocephalus, or it may be associated with other congenital anomalies in the spine
– A narrowing or blockage in the chambers of the brain where fluid circulates. (It occurs due to infection, tumor or bleeding in the vein.)
– Spina bifida and hydrocephalus, which are caused by abnormal development of the spine and a part of the spinal cord, can often coexist
– Congenital cysts in the brain: They can block the flow of fluid in the brain
– When parts of the brain do not develop properly
– It is a congenital disorder in the nape region where the brain and spinal cord meet.
– Premature birth
– Birth injuries
– Head traumas during childbirth
– Brain infections or infections in the womb
– Brain tumors
– Intracerebral hemorrhages: Usually, the brain chambers enlarge after spontaneous hemorrhages.
WHAT ARE THE SYMPTOMS OF HYDROCEPHALUS?
Symptoms seen in babies with hydrocephalus;
– Head larger than normal
– Swelling or tension in the fontanelles
– Vomiting
– Napping
– Poor diet
– Epileptic seizures
– Fixation of the eyes below. This image is called the setting sun view.
– Decrease in muscle tone and strength
– Poor response to touch
– Slowdown in growth
Symptoms of hydrocephalus in older infants and children;
– Headache
– Blurred or double vision
– Eyes fixed downwards (Setting sun scene)
– Abnormal enlargement of the head
– Sleepiness or drowsiness
– Nausea or vomiting
– Imbalance
– Poor Coordination
– Loss of appetite
– Epileptic seizures
– Incontinence
– Irritability
– Change in personality
– Decrease in school performance
– Problems with previously acquired skills such as walking or speaking
Symptoms seen in adults with hydrocephalus;
– Headache
– Sleepiness
– Loss of coordination and balance
– Loss of bladder control
– Frequent urge to urinate
– Visual impairment
– Memory, concentration problems and decreased thinking skills that can affect work performance
Symptoms of hydrocephalus in the elderly;
– Loss of bladder control or frequent urge to urinate
– Memory loss
– Progressive loss of thinking or reasoning skills
– Difficulty walking, poor coordination and balance
In addition to these, there are also laboratory signs (findings) of hydrocephalus. Laboratory symptoms of hydrocephalus include;
In normal pressure hydrocephalus, pressure at normal rates is detected in pressure measurements after cerebrospinal fluid intake from the lumbar spine region, called lumbar puncture. Standard cerebrospinal fluid biochemical examination of patients with normal pressure hydrocephalus is usually normal. Elevated levels of several biochemical markers have been reported. (Glial fibrillary acidic protein, synaptic membrane glycoprotein D2, homovanic acid, 5HIAA and lactic acid)
HOW IS HYDROCEPHALUS DIAGNOSED?
Brain CT: In most cases, CT scan shows the dimensional reduction of the brain tissue and the enlargement of the brain waterways.
Brain MRI: In patients with normal pressure hydrocephalus, widening of the brain waterways, detecting the flow of cerebrospinal fluid passing through the brain waterways, detecting changes in the brain tissue, makes the diagnosis easier.
Ultrasoundography: With the device called transcranial doppler ultrasonography, hydrocephalus can be diagnosed, especially in babies whose fontanelles are not closed.
In normal pressure hydrocephalus, normal pressure is detected in the pressure measurements after cerebrospinal fluid intake from the lumbar spine region, which is called lumbar puncture. Standard cerebrospinal fluid biochemical examination of patients with normal pressure hydrocephalus is usually normal. Elevated levels of several biochemical markers have been reported. (Glial fibrillary acidic protein, synaptic membrane glycoprotein D2, homovanic acid, 5HIAA and lactic acid)
HOW IS HYDROCEPHALU TREATED?
Medical treatment: In normal pressure hydrocephalus, some drugs that reduce cerebrospinal secretion can improve clinical findings.
Surgical treatment-Shunt treatment: The process of conveying the excess cerebrospinal fluid in the brain cavities to other body cavities through a thin tube under the skin.
Endoscopic third ventriculostomy: This method is the method of opening the cerebrospinal fluid circulation pathways (aquoductoplasty) or opening a new way (ventriculostomy) without a shunt.
What are the Types of Hydrocephalus?
Childhood Hydrocephalus:
Hydrocephalus is more common in childhood. Cerebral hemorrhages in the neonatal period develop due to obstruction in the water channels or decrease in reabsorption due to infection or brain tumors.
Adult Type Hydrocephalus:
Adult hydrocephalus is a rarer condition. Like childhood hydrocephalus, the tumor may be associated with infection or bleeding. The most common type is normal pressure hydrocephalus.
Normal Pressure Hydrocephalus:
Pressure occurs in the brain after excessive accumulation of cerebrospinal fluid in the brain cavities. It may cause walking with small steps, memory changes and urinary incontinence in the patient. Brain imaging and examinations should be performed to distinguish it from other diseases (such as Alzheimer’s and dementia) that cause similar pictures. When this disease is suspected, water is taken on the waist of the patient and the pressure is measured and it is tested whether the patient has benefited after the procedure. If there is improvement in the patient, surgical treatment should be performed.
Surgical methods in normal pressure hydrocephalus
Shunt Insertion:
It is the most commonly used treatment method. The principle of the method is based on discharging a thin tube placed in the enlarged brain cavities into the abdominal cavity under the skin in a way that is not visible from the outside. Excess water discharged into the abdominal cavity is absorbed from the peritoneum and mixed with the body. There is a risk of occlusion and infection. In such cases, the shunt should be removed and excess water should be taken out until the current situation improves. Shunt insertion and resolution of related problems is an issue that requires teamwork, which can only be done in certain clinics.
Endoscopic Method:
It is an operation to open an alternative flow branch to the enlarged brain cavities with the help of an endoscope through a hole in the brain. Although it is a good method for congenital waterway obstruction called aquadactyly stenosis.
When Should Hydrocephalus Be Treated?
Although the diagnosis of hydrocephalus can be made in the womb, treatment is not started until the baby is born. Medication is not possible and hydrocephalus is treated with surgical interventions. Selection of hydrocephalus treatment method; It depends on the cause of the obstruction that prevents the circulation of fluid (such as bleeding, tumor, cyst), the severity of the disease, your child’s age and general health.
Surgery can be performed to remove the tumor and cyst, as well as the surgical method called Shunt or Endoscopic third ventriculostomy, in which the blockage in the brain cavities is opened, may be preferred by the physician.
In babies diagnosed while in the mother’s womb; It is preferred that the baby is delivered as early as possible and the surgery is performed in the earliest period. In patients whose obstruction is not cleared, it is preferred to drain the excess fluid in the brain with a tube ‘shunt’ method. The goal of treatment is to drain fluid from the brain.
What Causes Hydrocephalus During Pregnancy?
Infections such as CMV (cytomegalovirus), rubella, mumps, syphilis and toxoplasmosis during pregnancy can cause hydrocephalus.
What Causes Hydrocephalus in the Elderly?
It is usually caused by the disease called Normal Pressure Hydrocephalus. In advanced ages, the absorption of cerebrospinal fluid is impaired and while the chambers in the brain grow, the brain begins to shrink. It is a syndrome in which cerebrospinal pressure is normal. The following symptoms associated with normal pressure hydrocephalus are common in individuals aged 60 and over:
– Urinary incontinence or frequent urge to urinate
– Memory loss
– Progressive loss of thinking or reasoning skills
– Difficulty walking
What Does the Setting Sun View Mean in Hydrocephalus?
Compression of the intracranial nerves can cause double vision by causing weakness in the eye muscles. As a result of the increase in pressure, upward gaze restriction may develop and this is called the setting sun view. Edema may be detected in fundus examination.
Can Hydrocephalus Patients Walk?
It is possible for patients diagnosed early and treated with appropriate treatment methods to walk and perform normal physical activities, but in delayed and untreated cases, mental retardation and walking problems may occur.
Is There a Herbal or Natural Treatment for Hydrocephalus?
There is no known herbal or natural treatment for hydrocephalus. In normal pressure hydrocephalus, some drugs that reduce cerebrospinal secretion can improve clinical findings.
What Should Be Considered After Hydrocephalus Surgery?
What are the Considerations After Shunt Surgery?
The first months after the operation are very important.
It gives signs of body rejection against a foreign object placed in the body. If conditions such as swelling and redness in the shunt area and opening of the sutures in the surgery area occur, a doctor should be consulted.
From public environments and sources of microbes; Dusty and respiratory conditions should be avoided.
If fever, fatigue, drowsiness and upper respiratory tract infection start after the operation, a doctor should be consulted.
After the operation, heavy work should not be done, heavy lifting should not be done and sports should not be done other than light sports exercises.
It is recommended to go to a doctor’s control at certain periods after the operation.
Can Hydrocephalus Be Detected in the Womb?
In the routine ultrasound test during pregnancy, your baby’s brain development is followed. Problems such as enlarged ventricles (venticles) or empty spaces (cysts) in the brain are visible on ultrasound.
What are the Risks of Hydrocephalus Surgery?
In addition to the benefits of the surgical procedure to be performed, there are also risks that may occur.
Anesthesia risk: There are risks during and after anesthesia procedures. In addition, there are complications and harms in all forms of anesthesia.
Abdominal complications: When placing the lower end of the shunt system into the abdomen, an injury to the small and/or large intestines may occur and therefore additional surgery may be required.
Bleeding: Although rare, there is a risk of advanced bleeding during or after surgery. In case of bleeding, additional treatment or blood transfusion may be needed.
Blood clot formation: Blood clots can occur after any type of surgery. Clots formed in the operation area (in the skull and in the abdominal cavity) prevent blood flow and complications such as pain, edema, inflammation, tissue damage and obstruction of the upper and/or lower end of the shunt may occur.
Brain and spinal cord damage: During the intervention, neural tissues (brain, spinal cord and nerves) may be damaged, which may lead to some functional disorders.
Problems with closure of the skin: Despite all surgical methods, it can be very difficult to cover the incision site with solid tissue. In these cases, skin openings may occur.
Cardiac complications: The surgery has a low risk of causing an irregular heart rhythm or heart attack.
Death: Although very rare, there is a risk of death during or after surgery.
Infection: Infection can occur in the skin incision area as well as in the surgical area. Risks due to infection may include meningitis (inflammation of the membranes surrounding the brain and spinal cord) and abscess (accumulation of pus). The shunt system can also become infected.
Respiratory problems: Postoperative respiratory distress or pneumonia, which is usually temporary, may occur. Pulmonary embolism (occlusion of the vessels of the lungs) may occur.
Seizure: An abnormal electrical event in the brain may cause seizures/convulsions, and this may be caused by complications in the intracranial part of the surgery.
Shunt not working: The shunt system is blocked and cannot function, this situation can be encountered in the early postoperative period, and there is such a risk in the long term.
Paralysis: In rare cases, partial or complete paralysis may develop due to tissue damage due to the application of the intracranial part of the shunt.
How Many Hours Does Hydrocephalus Surgery Take?
Hydrocephalus Shunt and Endoscopic third ventriculostomy surgeries take approximately 1 hour.
What is Head Circumference Measurement in Hydrocephalus?
By measuring the baby’s head circumference during periodic check-ups by a pediatrician, pediatric neurologist or neurosurgeon, early intervention is provided to problems that may arise in case the head circumference grows more than necessary.
Is Shunt Removal Required in Hydrocephalus?
If the shunt, called shunt infection or dysfunction, is blocked for any reason, it may be necessary to remove the shunt and then replace it with a drainage system or a new shunt.
Does Hydrocephalus Cause Dementia?
Dementia is observed in adults with normal pressure hydrocephalus. Normal pressure hydrocephalus can be confused with some other diseases that cause dementia. (such as Alzheimer’s, Parkinson’s, vascular dementia)
Does Hydrocephalus Cause Seizures?
Hydrocephalus, which occurs with the increase of cerebrospinal fluid in the brain, may cause epileptic seizures (convulsions) by compressing the brain tissue.
Which Department Should I Go To For Hydrocephalus?
Children; Brain, nerve and spinal cord surgery, Child and Child neurology clinics
Adults; Diagnosis and treatment are carried out in brain, nerve and spinal cord surgery and neurology clinics.
Is Physiotherapy Performed in Hydrocephalus?
– It is necessary to increase the strength of the muscles in the affected area and to apply personalized therapy.
– Studies to increase balance and coordination should be implemented, walking training should be done by increasing balance with robotic rehabilitation in today’s technology.
– Occupational therapy is a method that allows the person to adapt to daily life. At the same time, with the sensory integration training given, it helps the person to gain functions.
What Is Hydrocephalus Related To Using Folic Acid?
Diseases that require different brain, nerve and spinal cord surgery are frequently seen in babies at different periods. The most common of these diseases can be listed as fluid accumulation in the brain (hydrocephalus), spinal cord problems (Spina bifida) and brain tumors.
The use of folic acid, which is started 2 months before becoming pregnant, is helpful in preventing congenital spinal cord diseases by almost 70 percent. More than 85% of patients with Spina Bifida also have hydrocephalus.
Is Hydrocephalus Genetic?
Hydrocephalus can occur at any age, but often occurs in children and the elderly (over 60 years of age). Most patients with hydrocephalus are diagnosed at birth, prenatally, or in early infancy. Although rare, it may be due to genetic (inherited) disorders or developmental disorders.
Should Pregnancy Be Terminated Due to Hydrocephalus?
In hydrocephalus, the severity of the condition must be accurately determined. After diagnosis, families should be informed accurately. In severe cases, the family should be informed that they have the right to terminate the pregnancy with a committee report if they wish. The baby cannot be touched after the family does not want it, and the necessary examinations and treatments can be done after the birth.
Does Hydrocephalus Cause Vision Loss?
Vision loss, double or blurred vision problems may occur due to the effect of the optic nerves due to hydrocephalus.
Is There Hydrocephalus Drug Treatment?
Drug therapy is applied temporarily and rarely in some special cases in hydrocephalus. The aim of drug therapy is to reduce the production of cerebrospinal fluid as much as possible and to increase water excretion from the brain. Carbonic anhydrase inhibitors, loop diuretics, osmotic diuretics and fibrinolytic agents are some drugs used in medical therapy.
Does Hydrocephalus Cause Hearing Loss?
Hearing loss may occur in cases where hydrocephalus develops due to infection. Meningitis can have very serious consequences, including abscess of the brain or cerebellum, damage to the inner ear and permanent hearing loss.
Can Hydrocephalus Be Detected During Pregnancy?
Hydrocephalus can be noticed in ultrasound examinations during pregnancy follow-ups. Although the diagnosis of hydrocephalus is made by ultrasound, the diagnosis is supported by Fetal MRI. Fetal MRI can be performed during pregnancy as it does not contain radiation.
The fact that ultrasound is normal in any period of pregnancy does not mean that it will not develop in the future. It can be early or late onset. In some cases, hydrocephalus can be very severe with different diseases. However, in mild cases, a healthy birth process can be achieved by not showing any progress in hydrocephalus.”
A sample of amniotic fluid may be taken to check the baby’s chromosomes. Chromosome examination is performed with amniocentesis and chondocentesis.
During routine examinations by the pediatrician after birth, physical and motor development such as head circumference is followed, and the history of the disease in the family is taken. If the baby’s head circumference exceeds the limits that should be according to the month, hydrocephalus is investigated with various tests. With Brain Tomography, Magnetic Resonance Imaging, Brain Ultrasonography, the baby’s brain is displayed in detail.
Is Hydrocephalus Deadly?
Hydrocephalus usually does not heal on its own and cannot be treated with medication, often the only solution is surgery. Surgery should be performed as soon as possible after the disease is diagnosed. Most treated hydrocephalus patients can live long and problem-free lives. The disease can be fatal if left untreated.
Does Hydrocephalus Make You Sleep?
Hydrocephalus often makes you sleepy or lethargic
Does Hydrocephalus Cause Forgetfulness?
Dementia is observed in adults with normal pressure hydrocephalus. The most common problem experienced by dementia patients is forgetfulness. Normal pressure hydrocephalus can be confused with some other diseases that cause dementia. (such as Alzheimer’s, Parkinson’s, vascular dementia)
Is There a Link Between Hydrocephalus and Spina Bifida?
Spina bifida; means split or open spine. There are 3 shapes.
1) Spina Bifida Occulta
It is the lightest form. The back part of the spinal bones remains open. The finding does not cause any symptoms. It does not cause complaints. It is noticed by chance. It does not require treatment.
2) Meningocele
The membranes surrounding the spinal cord protrude from the back of the open vertebral bones. There are no nerves in the protruding part. There is only cerebrospinal water. Generally, there is no weakness in the legs, and there is no urinary-stool problem. Very rarely, there is a collection of water in the brain (hydrocephalus). With surgery, the open membrane and brain are repaired and the sac is closed.
3) Meningomyelocele
It is the most severe form. It is seen more frequently than meningocele. It is found in the nerves as well as the membranes that surround the spinal cord in the sac. These nerves, in addition to providing urine-stool control, go to the legs and provide movement and sensation. .The sac is closed surgically, but the lost functions can be partially restored.
Is Hydrocephalus a Cause of Parkinson's?
Parkinson’s disease is a disease caused by the loss of dopamine-producing cells in the brain, causing slowing of body movements and gait disturbance.
The most common problem experienced by patients with normal pressure hydrocephalus is the gait disorder called ataxic gait. Normal pressure hydrocephalus can be confused with some other diseases that cause gait disturbance. Therefore, it can be confused with Parkinson’s disease, which causes gait disturbance, but Hydrocephalus is not the cause of Parkinson’s.
Does Hydrocephalus Cause Mental Retardation?
Patients with hydrocephalus may have mental retardation. The occurrence of mental retardation depends on whether the brain is damaged or not. After a timely surgical intervention, a living child’s mental abilities have a chance to develop normally if brain tissue is not damaged. Patients with hydrocephalus treated include those with university education and high-level jobs. Early diagnosis is important in hydrocephalus. The absence of permanent damage to the brain depends on medical intervention as early as possible.
Does Hydrocephalus Harm the Mother?
Hydrocephalus can be noticed in ultrasound examinations during pregnancy follow-ups. Although the diagnosis of hydrocephalus is made by ultrasound, the diagnosis is supported by Fetal MRI.
The fact that ultrasound is normal in any period of pregnancy does not mean that it will not develop in the future. It can be early or late onset. In some cases, hydrocephalus can be very severe with different diseases. In mild cases, a healthy birth process can be achieved without the development of hydrocephalus.
If hydrocephalus in the baby endanger the mother’s life during pregnancy follow-ups, the pregnancy can be terminated. In cases of severe hydrocephalus, the family should be informed that they have the right to terminate the pregnancy with a committee report if they wish.
