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Hydrocephalus is very literally a condition of water on the brain. Broadly defined, hydrocephalus is a disturbance of the formation, flow, or absorption of cerebrospinal fluid that causes an unusual accumulation of fluid in and around the brain.

Hydrocephalus- disturbance of absorption of cerebrospinal fluid

Occurring over days, months, or years, pressure inside the skull can lead to lesions in the brain, or complete destruction of brain tissue.

Congenital hydrocephalus occurs in newborns. Typically due to barriers to the flow of cerebrospinal fluid, congenital hydrocephalus is often associated with a larger than normal head. The brains of babies born with this condition often learn to compensate for pressure on tissues, symptoms only occurring later in life after a head injury.

Communicating hydrocephalus occurs in adults when the brain does not absorb cerebrospinal fluid. Noncommunicating hydrocephalus occurs when fluid cannot flow through the brain. And, in older adults, normal pressure hydrocephalus is a condition in which pressure in the brain is sometimes normal and sometimes elevated, the pressure of fluid usually greatest at night. Fluid in the brain in this form of hydrocephalus usually does not cause headaches, but it does interfere with normal stride and usually causes both incontinence and dementia.

In Canada and the United States, about 1 in 300 babies is born with hydrocephalus. Every year about 10,000 Canadians and about 100,000 Americans receive surgery to place shunts in their brains to drain accumulated excesses of cerebrospinal fluid.

About 60 per cent of cases of hydrocephalus occur in infancy. About 40 per cent occur in adulthood, usually after the age of 40.

The symptoms of hydrocephalus in newborns, children and adults

The symptoms of hydrocephalus. Accumulated fluid in the skull does not usually cause any immediately obvious symptoms except in newborns. The manifestations of this condition differ greatly by age.

Symptoms in newborns include:

  • Lack of activity
  • Disinterest in feeding
  • Irritability
  • Vomiting

Symptoms in children include:

  • Headaches that are usually worse in the morning. Infants do not suffer headaches because their skulls are more flexible.
  • Complaint of sore throat or sore tonsils without any obvious inflammation or irritation.
  • Vomiting, also usually worse in the morning.
  • Drowsiness.
  • Blurred vision.
  • Slowing of mental development.
  • Puberty may be either precocious or delayed.
  • Obesity.
  • Spastic muscle motions that can result in difficulty walking.

Symptoms in adults include:

  • Headaches, usually worse in the morning. Headaches are worse in the morning because the brain and spinal cord absorb less spinal fluid when the person lies down. Normal pressure hydrocephalus seldom causes headache.
  • Mental deterioration that can be hard to distinguish from other brain diseases.
  • Explosive vomiting, especially in the morning.
  • Tonsil pain without tonsillitis.
  • Drowsiness.
  • Dizziness.
  • Difficulty walking.
  • Urinary incontinence followed by fecal incontinence.
  • Blurred vision. "Graying out" of the vision is a medical emergency.

Symptoms of normal pressure hydrocephalus in older adults include:

  • Difficulties in walking, specifically feet that seem "stuck on the floor."
  • Difficulties with recent memory, difficulties in recalling quickly.
  • Feeling a need to urinate all the time, or not being aware of a need to urinate.
  • Personality changes.
  • Parkinson's symptoms (shaking on one side, freezing in place, muscle problems go away once the muscles are in motion).

In some cases, giving an infant too much vitamin A can result in hydrocephalus. Fluid can accumulate on the brain as a result of bleeding in the brain (cerebral hemorrhage), infection with meningitis or cysticercosis, or from any of a number of different kinds of brain tumors, many of which are not malignant. These types of tumors include hypothalamic or optic nerve glioma, hamartoma, ependymoma, choroid plexus papilloma, craniopharyngioma, subependymal giant cell astrocytoma, pituitary adenoma, and also metastatic, cancerous tumors.

Medical and surgical treatment of hydrocephalus

Medical treatment of hydrocephalus is usually intended to delay the need for surgery. Giving people diuretics indirectly relieves the buildup of fluid in the brain, but also robs the body of important electrolytes. The drug isosorbide is given to "mop up" fluid on the brain, but it is of limited value. Long-term treatment of hydrocephalus almost always involves surgery.

Surgical treatment of hydrocephalus can be as simple as a lumbar puncture or "spinal tap." About 75 per cent of people who have hydrocephalus, however, eventually need brain surgery for placement of a shunt to relieve the buildup of fluid on the brain.

When children are given shunts, there is a regular schedule of surgical adjustments of the shunt to keep up with the child's growing body. When adults are given shunts, the shunt is usually not replaced unless there is an issue with malfunction or infection. Typically, a CT ("CAT") scan or MRI is only done once, about three months after the shunt is put in. Doctors are able to determine the location and function at later dates through other means of examination.

Many people who are given shunts to remove accumulated cerebrospinal fluid are also given diuretics to increase urination and remove fluid from the body. Anyone who takes a diuretic on an ongoing basis is at risk for depletion of magnesium, potassium and B vitamins. Since magnesium, in particular, may interact with medications for seizures, it is important to work with the doctor, rather than independently of the doctor, in determining any program of nutritional supplementation. Special diet usually is not required for people with hydrocephalus, although excessive consumption of salt should be avoided.

In people who take diuretics, extreme fatigue, diarrhea, double vision, and shortness of breath are signals of a need for emergency medical treatment.

Spina Bifida and Hydrocephalus Awareness Month in Canada. The Canadian government has worked with the Spina Bifida and Hydrocephalus Society of Canada to make June 2010 Canada's National Spina Bifida and Hydrocephalus Awareness Month. Vitapath Genetics is sponsoring the society's third annual National Walk Run Wheel Event to raise funds for spina bifida and hydrocephalus research. Most Canadian cities will have their events on August 21, 2010, but some locations may have the fundraising event on other dates to match local events.

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