Hydrocephalus

Subject: Midwifery III (Theory)

Overview

Abnormal buildup of cerebrospinal fluid (CSF) in the brain is medically known as hydrocephalus (from the Greek hydro-, meaning "water," and kephalos, meaning "head"). If this happens to a child, they may have convulsions, tunnel vision, and mental impairment due to the increased intracranial pressure that might result from a growing head. Hydrocephalus, sometimes known informally as "Water on the brain," is an unknown and likely complex origin. In infants with hydrocephalus, CSF accumulates in the central nervous system, leading to a bulging fontanelle(soft spot) and a larger-than-average head. Other symptoms include headaches, vomiting, nausea, papilledema, sleepiness, and coma. Hydrocephalus can also be caused by overproduction of cerebrospinal fluid (relative obstruction) (e.g.,Choroid plexus papilloma, villous Hydrocephalus can be fatal if left untreated because it raises pressure inside the skull, which can cause uncal and/or cerebellar tonsillar herniation and other potentially fatal complications in the brain stem. Existing brain damage may be irreversible despite treatment. Stopping any more brain damage from happening is the main focus. CSF flow must be returned to normal in order to do this.

An abnormal buildup of CSF in the brain is known medically as hydrocephalus (from the Greek hydro-, meaning "water," and cephalous, meaning "head"). If this happens to a child, it might lead to a lifetime of complications including convulsions, tunnel vision, and cognitive impairment due to the increased pressure inside the skull. An old nickname for this condition was "Water on the brain."

Causes:

The origin of hydrocephalus may be genetic or environmental.

  • Spina bifida, Arnold-Chiari malformation, craniosynostosis, Dandy-Walker syndrome, and vein of Galen abnormalities are all examples of conditions that have their origins at birth. Hemorrhage, meningitis, brain damage, tumors, and cysts are all examples of acquired causes.
  • Hydrocephalus has an unknown and likely complex origin. Problems with cerebrospinal fluid (CSF) circulation, reabsorption, or production might be to blame.
  • Blockages in the flow of cerebrospinal fluid (CSF) between the ventricular system and subarachnoid space (such as stenosis of the cerebral aqueduct or blockage of the interventricular foramina) as a result of tumors, hemorrhages, infections, or congenital anomalies can lead to rises in central nervous system pressure.
  • Overproduction of cerebrospinal fluid (relative blockage) is another possible cause of hydrocephalus (e.g.,Choroid plexus papilloma, villous hypertrophy).
  • While hydrocephalus due to bilateral ureteral blockage is uncommon, it has been documented.


The Symptoms:

Increased pressure inside the skull can cause a variety of symptoms:

  • Headaches, vomiting, nausea, papilledema, sleepiness or coma.
  • Elevated intracranial pressure may result in uncaland/or cerebellar tonsil herniation, with resulting life-threatening brain stem.
  • When cerebrospinal fluid (CSF) accumulates in an infant's brain, it causes the fontanelle (soft spot) to protrude and the head to grow bigger than normal.

Some other possible early indications are:

  • The eyes seem to be looking down
  • Irritability
  • Seizures
  • broken sutures
  • Sleepiness

In older kids, you could see symptoms like:

  • Extremely brief, high-pitched cry.
  • Changes in one's character, recollection, or analytical skills;
  • Variations in the size and placement of the eyes;
  • Eyes that are crossed or dart about uncontrollably;
  • Problems with eating and sleeping too much
  • Problems with walking and coordination, headaches, irritability, and loss of bladder control are all possible side effects of this medication.
  • Spasticity (tightness) of the muscles
  • Slowed development in infants and young children;
  • Inability to move freely
  • Vomiting

Diagnosis:

  • Examining the patient's physical state for symptoms. Observe for signs of a larger-than-average head circumference, a sunken fontanel, delayed reflexes, and sunken eyes.
  • An ultrasonic examination of the brain. These evaluations provide pictures of the brain using high-frequency sound waves.
  • You may check for evidence of too much CSF using an MRI scan.
  • Computed Tomography Scan (CT) Exams

Treatment:

If hydrocephalus goes untreated, it might cause death. Existing brain damage may be irreversible despite treatment. Stopping any more brain damage from happening is the main focus. CSF flow must be returned to normal in order to do this. Your surgeon may consider one of the two following procedures:

Shunt insertion:

Surgery to implant a shunt is the usual treatment. A lengthy tube with a valve, the shunt is a drainage system. The valve promotes healthy, forward-moving circulation of cerebrospinal fluid. A portion of the tube will be placed in your brain, and the other portion will be placed in your chest or abdomen by your doctor. The brain's excess fluid then travels down the tube and out the other end, where it may be absorbed more readily. A shunt implant is usually permanent and requires ongoing follow-up care.


Ventriculostomy:
An alternative to shunt insertion is a technique termed a ventriculostomy, which involves creating a new opening between the ventricles of the brain. Making a hole at the base of a ventricle or in the space between ventricles accomplishes this. By doing so, CSF can drain from the brain.
Things to remember
  • The medical disorder known as hydrocephalus, named after the Greek words for "water" (hydro-) and "head" (kephalos), refers to an abnormal buildup of CSF in the brain.
  • If this happens to a kid, it can lead to convulsions, tunnel vision, and cognitive impairment due to the increased intracranial pressure that results from the ensuing head growth.
  • An old nickname for this condition was "Water on the brain."
  • Hydrocephalus has an unknown and likely complex origin.
  • Causes include abnormal CSF generation, reabsorption, or flow.
  • Overproduction of cerebrospinal fluid (relative blockage) is another possible cause of hydrocephalus (e.g.,Choroid plexus papilloma, villous hypertrophy).
  • When cerebrospinal fluid (CSF) accumulates in an infant's brain, it causes the fontanelle (soft spot) to protrude and the head to grow bigger than normal.
  • Discomfort, nausea, vomiting, papilledema, drowsiness, and even coma may result.
  • Uncal and/or cerebellar tonsillar herniation, both of which can be fatal, are signs of elevated intracranial pressure that affect the brain stem.
  • If hydrocephalus is not treated, it can be deadly.
  • Existing brain damage may be irreversible despite treatment. Stopping any more brain damage from happening is the main focus.
  • CSF flow must be returned to normal in order to do this.
Questions and Answers

The medical disorder known as hydrocephalus, which derives from the Greek words hydro-, which means "water," and kephalos, which means "head," is characterized by an abnormal buildup of cerebrospinal fluid (CSF) in the brain. If it happens in children, it may result in increasing expansion of the head, increased intracranial pressure, convulsions, tunnel vision, and mental impairment. "Water on the brain" was the former colloquial name for it.

Causes

Both congenital and acquired factors may contribute to hydrocephalus.

  • Spina bifida, Arnold-Chiari malformation, craniosynostosis, Dandy-Walker syndrome, and Vein of Galen abnormalities are examples of congenital causes. Hemorrhage, Meningitis, Head Trauma, Tumors, and Cysts are examples of acquired causes.
  • Although the exact cause of hydrocephalus is unknown, it is likely complex. It could be brought on by poor cerebrospinal fluid (CSF) flow, reabsorption, or overproduction of CSF.
  • Increases in central nervous system pressure can result from obstructions to CSF flow, which prevent the fluid from freely flowing through the ventricular system and subarachnoid space (e.g., stenosis of the cerebral aqueductor obstruction of the interventricular foramina secondary to tumors, hemorrhages, infections, or congenital malformations).
  • Overproduction of cerebrospinal fluid (relative blockage) can potentially result in hydrocephalus (e.g.,Choroid plexus papilloma, villous hypertrophy).
  • Although uncommon, bilateral ureteric blockage has been implicated as a cause of hydrocephalus.

 

Treatment

If hydrocephalus is not treated, it can be fatal. Treatment might not be able to undo existing brain damage. The intention is to stop additional brain deterioration. This entails reestablishing the CSF's regular flow. Your doctor may investigate one or both of the following surgical possibilities:

  • Shunt Insertion
    • A shunt is often implanted surgically. A lengthy tube with a valve serves as the drainage system for the shunt. The valve aids in regulating the rate and direction of CSF flow. The tube is placed with one end in the brain and the other in the chest or abdomen by your doctor. The extra fluid is subsequently removed from the brain and exits the tube at the opposite end, where it can be taken up more quickly. Shunt implants must be periodically checked and are often permanent.
  • Ventriculostomy
    • An alternative to having a shunt implanted is a technique termed a ventriculostomy. To do this, a hole must be made at the base of a ventricle or between ventricles. CSF may now exit the brain as a result.

Increased intracranial pressure symptoms could include

  • Headaches, nausea, papilledema, vomiting, lethargy, or a coma. Uncal and/or cerebellar tonsillar herniation may occur as a result of increased intracranial pressure, endangering the life of the brain stem.
  • CSF accumulates in the central nervous system of newborns with hydrocephalus, causing the fontanelle (soft spot) to enlarge and the head to be larger than normal.

Other possible early signs include:

  • Eyes that appear to be looking down
  • Irritability
  • Seizures
  • Divided sutures
  • Sleepiness

Symptoms that could manifest in older kids include:

  • High-pitched, loud wail that is brief.
  • Changes to one's personality, memory, or capacity for thought.
  • The spacing and shape of the eyes have changed.
  • Eyes that are crossed or have erratic eye movement.
  • A problem feeding.
  • Extreme drowsiness
  • Headache.
  • Impatience and inadequate self-control.
  • Bladder control issues (urinary incontinence).
  • Walking difficulties and a loss of coordination.
  • Muscle rigidity (spasm).
  • Modest growth (child 0–5 years).
  • Limited or sluggish movement
  • Vomiting.

 

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