The term hydrocephalus comes from Greek: hydro = water, kephale = head and it means an increased accumulation of liquid (cerebrospinal fluid) in the ventricles of the brain. The cerebrospinal fluid is produced at a rate of 15 – 30 ml per hour. The total amount of cerebrospinal fluid in an adult person is around 150 ml and it turns over about 3 times a day. From the place of its production to the place of resorption the cerebrospinal fluid circulates through the whole ventricular system of the brain. The passage of cerebrospinal fluid may be blocked anywhere in the system – when it is obstructed, we speak of obstructive hydrocephalus. When the problem occurs in the resorption of the fluid, it is called hyporesorptive hydrocephalus.

Causes of hydrocephalus

Hydrocephalus is in rare cases congenital or associated with congenital disorders such as spina bifida (congenital defect of the development of the spine and the spinal cord) or encephalocele. It more frequently develops as a consequence of bleeding, head traumas, infections (brain infections, meningitis) or brain surgeries.

Symptoms

The symptoms of hydrocephalus may vary, however, the most frequent ones are listed in the following paragraph.

Symptoms of hydrocephalus in infants include the following: progressive enlargement of the head, bulging fontanelles, thin and tight scalp with distended scalp veins, separation of skull bones, vomitting, lack of appetite, irritability.

Hydrocephalus in toddlers and older children includes the following symptoms: progressive enlargement of the head, headaches, nausea, vomitting, fever, blurred or double vision, irritability, drowsiness, psycho-motor retardation, loss of coordination, behavioral changes, lack of concentration, seizures, lack of appetite

Symptoms of hydrocephalus in adolescents and adults: headaches, drowsiness, loss of coordination, urinary and faecal incontinence, blurred or double vision, deteriorating mental status

Symptoms of hydrocephalus in older adults: loss of coordinated walking, memory loss, headaches, urinary and faecal incontinence

Diagnostics

Clinical examination, ultrasound examination (in infants and small children), CT – computer tomography, MRI – magnetic resonance imaging, LIT – lumbar infusion test (test assessing the cerebrospinal fluid resorption capacity).

Treatment

The most frequent procedure is the ventriculo-peritoneal shunt which drains the excess fluid from cerebral ventricles through a one-way valve into the peritoneal cavity under the skin. The flow of the fluid is regulated by the selected opening pressure of the valve. A neurosurgeon drills a hole in the skull and inserts a catheter into a ventricle, the other end of the catheter is inserted into the peritoneal cavity where the fluid is resorbed. In some cases, for instance in patients who have had many abdominal surgeries, it is more appropriate to insert the draining catheter through the venous system into the heart. Some cases of obstructive hydrocephalus are treated by creating an alternate communication which bypasses the obstruction in the fluid circulation. This procedure is called the third ventriculostomy and is performed endoscopically.

Patient's gait before and after treatment

Definitions

hydrocephalus – pathological enlargement of the ventricular system caused by an excess of cerebrospinal fluid

obstructive hydrocephalus – enlargement of the ventricular system caused by an obstruction in the passage of cerebrospinal fluid circulation

normotensive hydrocephalus – abnormal expansion of the ventricular system in the brain caused by inadequate resorption of the cerebrospinal fluid

shunt – an artificially created passage between the ventricular system of the brain and other body cavity (most often the peritoneal cavity)

ventriculomegaly – abnormal expansion of the ventricular system of the brain