Hydrocephalus

Hydrocephalus, also known as “water in the brain,” is a serious condition affecting approximately 85 out of 100,000 individuals worldwide. Some reports even indicate that up to two of every 1,000 babies are born with this condition. Although hydrocephalus has no cure, treatment options can help prevent further health complications and enable a patient to live a normal life.

At Nacogdoches Medical Partners in Nacogdoches, TX, we have neurologists, neurosurgeons and other doctors with extensive education and experience in treating hydrocephalus and related conditions. Our multidisciplinary medical team works together to care for our patients and develop the best possible treatment plan, from diagnosis, evaluation and treatment to follow-up and family support. Count on us to provide you with available safe and effective treatment options for hydrocephalus.

What Is Hydrocephalus?

Cerebrospinal fluid (CSF) protects and nourishes the brain and removes waste from it. It flows through the brain’s four ventricles, which are chambers filled with fluid. The body normally produces enough CSF daily and reabsorbs the same amount. Hydrocephalus happens when there is an imbalance between the CSF production and the rate it’s absorbed back.

Hydrocephalus comes from the Greek words “hydro” (water) and “cephalus” (head). It refers to the buildup of excess (CSF) within the brain ventricles. Excess CSF can add pressure to the brain and keep it from functioning correctly, leading to brain damage or even death if left untreated. Hydrocephalus can happen to anyone at any age, but it’s most common in babies and adults 60 years old and above.

Hydrocephalus symptoms in babies may include:

• Unusually large head
• Rapid increase in head size
• Bulge on the fontanel (soft spot on the baby’s head)
• Eyes that are fixed downwards
• Difficulty feeding or sucking

Hydrocephalus in adults and older children may have these symptoms:

• Headache
• Vision problems
• Problems with balance
• Difficulty staying awake or waking up
• Cognitive or personality changes

Hydrocephalus symptoms in older adults may include:

• Difficulty walking
• Poor balance and coordination
• Dementia or progressive mental impairment
• Frequent urination or loss of bladder control
• General slowing of movements

What Causes Hydrocephalus?

Infants may be born with hydrocephalus or develop it shortly after birth. In these cases, hydrocephalus may be caused by the following:

• Premature birth complications
• Developmental abnormalities present at birth
• Infection during pregnancy
• Inherited genetic disorders that result in CSF flow blockage

The following are some factors that can increase the risk of developing hydrocephalus at any age:

• Brain or spinal cord tumors
• Infections of the central nervous system
• Stroke or injury that causes brain bleeding

What Are the Types of Hydrocephalus?

• Congenital hydrocephalus – hydrocephalus that is present at birth or developed later on in life due to another condition that existed at birth.
• Acquired hydrocephalus – hydrocephalus that develops after birth. It can be caused by brain tumors, head injuries, brain bleeding or infection of the spinal cord or brain.
• Communicating hydrocephalus – there is no obstruction of CSF flow in the brain’s ventricular system, but hydrocephalus exists because of either CSF overproduction or inadequate absorption of CSF.
• Non-communication (obstructive) hydrocephalus – the CSF flow is blocked in one or more passages that connect the ventricles and leading to increased pressure within the skull.
• Normal pressure hydrocephalus – brain ventricles enlarge but with little to no pressure increase within the ventricles.
• Hydrocephalus ex-vacuo – occurs when stroke, Alzheimer’s or other degenerative disease damages the brain and shrinks the brain tissue.

How Is Hydrocephalus Diagnosed?

Doctors use clinical neurological exams, brain imaging and other tests based on the patient’s age, symptoms and known or suspected medical conditions affecting the brain or spinal cord. A neurological examination involves tests to determine a patient’s:

• Balance and coordination
• Muscle reflexes and strength
• Eye movement, vision and hearing
• Mood and mental functioning

The following tests may be ordered to accurately diagnose hydrocephalus:

• Computed tomography (CT) scan – lets doctors see if there is obstruction in the ventricles or if they’re enlarged.
• Fundoscopic examination – aims to check the eye’s optic nerve for swelling, which can suggest pressure in the skull due to hydrocephalus.
• Intracranial pressure monitoring – aims to measure the brain for any increased pressure and swelling.
• Magnetic resonance imaging (MRI) – aims to assess CSF flow, determine if there’s ventricular enlargement and provide other information about the brain tissue that surrounds the ventricles.
• Spinal tap – extracting a sample of CSF from the patient for testing.
• Ultrasound – a low-risk and simple test used for diagnosing hydrocephalus in infants. Ultrasound may also be used during prenatal exams to see if an unborn baby has this condition.

How Is Hydrocephalus Treated?

Our medical team works together on every aspect of our patient’s care to determine the most appropriate treatment for them. The goal of hydrocephalus treatment is to properly drain excess CSF to reduce pressure in the patient’s head. Since there is no nonsurgical treatment for hydrocephalus at the moment, the condition must be treated through hydrocephalus surgery. Surgical options include:

• Shunt – the neurosurgeon places a flexible medical tube called a shunt into the brain’s ventricular system. This aims to divert the CSF flow to another region of the body, such as the heart or abdominal cavity where CSF can be absorbed.
• Endoscopic Third Ventriculostomy (ETV) – the neurosurgeon uses an endoscope (long, thin tube with a tiny camera) to pierce a membrane on the brain’s third ventricle to create a pathway for the CSF to leave the ventricular system. This procedure is usually performed in children over two years old.
• ETV with Choroid Plexus Cauterization (CPC) – this can be a primary treatment option for children under two years old. The neurosurgeon performs ETV then burns (cauterizes) choroid plexus tissue (which produces CSF) to reduce its fluid production.

Compassionate Care for Hydrocephalus Patients

Hydrocephalus is a complex condition requiring specialized care and treatment. At Nacogdoches Medical Partners, we understand the challenges faced by patients with this condition and their families. We are committed to providing compassionate care that meets the unique needs of our patients. If you or a loved one is facing hydrocephalus, we’re here to help. Contact us today to learn how we can care for you.