Hydrocephalus at different ages: treatment with brain shunting
Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain.
Cerebrospinal fluid normally flows through the ventricles and bathes the brain and spinal column. But the pressure of too much cerebrospinal fluid associated with hydrocephalus can damage brain tissues and cause a range of impairments in brain function.
Hydrocephalus can happen at any age, but it occurs more frequently among infants (pediatric hydrocephalus) and adults 60 and over. Surgical treatment for hydrocephalus can restore and maintain normal cerebrospinal fluid levels in the brain. Many different therapies are often required to manage symptoms or functional impairments resulting from hydrocephalus.
causes of Hydrocephalus
Hydrocephalus is caused by an imbalance between how much cerebrospinal fluid is produced and how much is absorbed into the bloodstream.
Cerebrospinal fluid is produced by tissues lining the ventricles of the brain. It flows through the ventricles by way of interconnecting channels. The fluid eventually flows into spaces around the brain and spinal column. It's absorbed primarily by blood vessels in tissues near the base of the brain.
Cerebrospinal fluid plays an important role in brain function by:
- Keeping the brain buoyant, allowing the relatively heavy brain to float within the skull
- Cushioning the brain to prevent injury
- Removing waste products of the brain's metabolism
- Flowing back and forth between the brain cavity and spinal column to maintain a constant pressure within the brain — compensating for changes in blood pressure in the brain
Excess cerebrospinal fluid in the ventricles occurs for one of the following reasons:
The most common problem is a partial obstruction of the normal flow of cerebrospinal fluid, either from one ventricle to another or from the ventricles to other spaces around the brain.
- Poor absorption
Less common is a problem with the mechanisms that enable the blood vessels to absorb cerebrospinal fluid. This is often related to inflammation of brain tissues from disease or injury.
Rarely, cerebrospinal fluid is created more quickly than it can be absorbed So it accumulates.
symptoms of hydrocephalus
The signs and symptoms of hydrocephalus vary somewhat by age of onset.
Common signs and symptoms of hydrocephalus in infants include:
Changes in the head
- An unusually large head
- A rapid increase in the size of the head
- A bulging or tense soft spot (fontanel) on the top of the head
Physical signs and symptoms
- Poor feeding
- Eyes fixed downward (sunsetting of the eyes)
- Deficits in muscle tone and strength
- Poor responsiveness to touch
- Poor growth
Toddlers and older children
Among toddlers and older children, signs and symptoms may include:
Physical signs and symptoms
- Blurred or double vision
- Eyes fixed downward (sunsetting of eyes)
- Abnormal enlargement of a toddler's head
- Sleepiness or lethargy
- Nausea or vomiting
- Unstable balance
- Poor coordination
- Poor appetite
- Urinary incontinence
Behavioral and cognitive changes
- Change in personality
- Decline in school performance
- Delays or problems with previously acquired skills, such as walking or talking
Young and middle-aged adults
Common signs and symptoms in this age group include:
- Loss of coordination or balance
- Loss of bladder control or a frequent urge to urinate
- Impaired vision
- Decline in memory, concentration and other thinking skills that may affect job performance
Among adults 60 years of age and older, the more common signs and symptoms of hydrocephalus are:
- Loss of bladder control or a frequent urge to urinate
- Memory loss
- Progressive loss of other thinking or reasoning skills
- Difficulty walking, often described as a shuffling gait or the feeling of the feet being stuck
- Poor coordination or balance
When to see a doctor
Seek emergency medical care for infants and toddlers experiencing these signs and symptoms:
- A high-pitched cry
- Problems with sucking or feeding
- Unexplained, recurrent vomiting
- An unwillingness to move the head or lay down
- Breathing difficulties
Seek prompt medical attention for other signs or symptoms in any age group.
Because more than one condition can result in the problems associated with hydrocephalus, it's important to get a timely diagnosis and appropriate care.
In many cases, the exact event leading to hydrocephalus is unknown. However, a number of developmental or medical problems can contribute to or trigger hydrocephalus.
Hydrocephalus present at birth (congenital) or shortly after birth may occur because of any of the following:
- Abnormal development of the central nervous system that can obstruct the flow of cerebrospinal fluid
- Bleeding within the ventricles, a possible complication of premature birth
- Infection in the uterus during a pregnancy, such as rubella or syphilis, that can cause inflammation in fetal brain tissues
Other factors that can contribute to hydrocephalus among any age group include:
- Lesions or tumors of the brain or spinal cord
- Central nervous system infections, such as bacterial meningitis or mumps
- Bleeding in the brain from a stroke or head injury
- Other traumatic injury to the brain
Long-term complications of hydrocephalus can vary widely and are often difficult to predict.
If hydrocephalus has progressed by the time of birth, it may result in significant intellectual, developmental and physical disabilities. Less severe cases, when treated appropriately, may have few, if any, serious complications.
Adults who have experienced a significant decline in memory or other thinking skills generally have poorer recoveries and persistent symptoms after treatment of hydrocephalus.
The severity of complications depends on the following:
- Underlying medical or developmental problems
- Severity of initial symptoms
- Timeliness of diagnosis and treatment
A diagnosis of hydrocephalus is usually based on:
- Your answers to the doctor's questions about signs and symptoms
- A general physical
exams and imaging tests are also taken:
The type of neurological exam will depend on a person's age. The neurologist may ask questions and conduct relatively simple tests in the office to judge muscle condition, movement, well-being and how well the senses are functioning.
Brain imaging tests can show enlarged ventricles caused by excess cerebrospinal fluid. They may also be used to identify underlying causes of hydrocephalus or other conditions contributing to the symptoms. Imaging tests may include:
Ultrasound imaging, which uses high-frequency sound waves to produce images, is often used for an initial assessment for infants because it's a relatively simple, low-risk procedure. The ultrasound device is placed over the soft spot (fontanel) on the top of a baby's head. Ultrasound may also detect hydrocephalus prior to birth when the procedure is used during routine prenatal examinations.
- Magnetic resonance imaging (MRI)
MRI uses radio waves and a magnetic field to produce detailed 3-D or cross-sectional images of the brain. This test is painless, but it is noisy and requires lying still.
Children may need mild sedation for some MRI scans. However, some hospitals use a very fast version of MRI that generally doesn't require sedation.
- Computerized tomography (CT)
CT scan is a specialized X-ray technology that can produce cross-sectional views of the brain. Scanning is painless and quick. But this test also requires lying still, so a child usually receives a mild sedative.
Drawbacks to CT scanning include less detailed images than an MRI, and exposure to a small amount of radiation. CT scans for hydrocephalus are usually used only for emergency exams.
One of two surgical treatments may be used to treat hydrocephalus.
Reflexology, acupuncture, and bioenergetics, as well as other energetic medicines will be a great help for your body in reestablishing balance. Bioenergetic massage are especially recommendable because they help the body reestablish natural in organs and systems.
A high alkaline diet may help manage hydrocephalus. It consists of 80% alkaline foods (which are fruits and vegetables) and 20% acidic foods, and 80% raw foods (preferably organic) and 20% cooked foods (vegan in nature – no meat and/or dairy products).
Plenty of good drinking water should be consumed daily, especially alkaline water and vegetable juice as well should be consumed daily or as often as possible.
The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate.
One end of the tubing is usually placed in one of the brain's ventricles. The tubing is then tunneled under the skin to another part of the body where the excess cerebrospinal fluid can be more easily absorbed — such as the abdomen or a chamber in the heart.
People who have hydrocephalus usually need a shunt system for the rest of their lives, and regular monitoring is required.
Endoscopic third ventriculostomy
Endoscopic third ventriculostomy is a surgical procedure that can be used for some people. In the procedure, your surgeon uses a small video camera to have direct vision inside the brain. Your surgeon makes a hole in the bottom of one of the ventricles or between the ventricles to enable cerebrospinal fluid to flow out of the brain.
Complications of surgery
Both surgical procedures can result in complications. Shunt systems can stop draining cerebrospinal fluid or poorly regulate drainage because of mechanical malfunctions, blockage or infections. Complications of ventriculostomy include bleeding and infections.
Any failure requires prompt attention, surgical revisions or other interventions. Signs and symptoms of problems may include:
- Nausea or vomiting
- Vision problems
- Redness, pain or tenderness of the skin along the path of the shunt tube
- Abdominal pain when the shunt valve is in the abdomen
- Recurrence of any of the initial hydrocephalus symptoms
Some people with hydrocephalus, particularly children, may need additional treatment, depending on the severity of long-term complications of hydrocephalus.
A care team for children may include a:
- Pediatrician or physiatrist, who oversees the treatment plan and medical care
- Pediatric neurologist, who specializes in the diagnosis and treatment of neurological disorders in children
- Occupational therapist, who specializes in therapy to develop everyday skills
- Developmental therapist, who specializes in therapy to help your child develop age-appropriate behaviors, social skills and interpersonal skills
- Mental health provider, such as a psychologist or psychiatrist
- Social worker, who assists the family with accessing services and planning for transitions in care
- Special education teacher, who addresses learning disabilities, determines educational needs and identifies appropriate educational resources
Adults with more-severe complications also may require the services of occupational therapists, social workers, specialists in dementia care or other medical specialists.
Hydrocephalus isn't a preventable condition. However, there are ways to potentially reduce the risk of hydrocephalus:
- If you're pregnant, get regular prenatal care
Following your doctor's recommended schedule for checkups during pregnancy can reduce your risk of premature labor, which places your baby at risk of hydrocephalus and other complications.
- Protect against infectious illness
Follow the recommended vaccination and screening schedules for your age and sex. Preventing and promptly treating the infections and other illnesses associated with hydrocephalus may reduce your risk.
To prevent head injury:
- Use appropriate safety equipment
For babies and children, use a properly installed, age- and size-appropriate child safety seat on all car trips. Children and adults should wear helmets while riding bicycles, skateboards, motorcycles, snowmobiles or all-terrain vehicles.
- Always wear a seat belt in a motor vehicle
Small children should be secured in child safety seats or booster seats. Depending on their size, older children may be adequately restrained with seat belts.
Ask your doctor if you or your child should receive a vaccine against meningitis, once a common cause of hydrocephalus. The Centers for Disease Control and Prevention recommends meningitis vaccination for preteen children and boosters for teenagers. It's also recommended for younger children and adults who may be at increased risk of meningitis for any of the following reasons:
- Traveling to countries where meningitis is common
- Having an immune system disorder called terminal complement deficiency
- Having a damaged spleen or having had the spleen removed
- Living in a college dormitory
- Joining the military