What is Hydrocephalus?
Hydrocephalus is a condition in which the primary characteristic
is excessive accumulation of fluid in the brain. Although
hydrocephalus was once known as "water on the brain," the "water"
is actually cerebrospinal fluid (CSF) -- a clear fluid surrounding
the brain and spinal cord. The excessive accumulation of CSF
results in an abnormal dilation of the spaces in the brain called
ventricles. This dilation causes potentially harmful pressure on
the tissues of the brain. Hydrocephalus may be congenital or
acquired. Congenital hydrocephalus is present at birth and may be
caused by genetic abnormalities or developmental disorders such as
spina bifida and encephalocele. Acquired hydrocephalus develops at
the time of birth or at some point afterward and can affect
individuals of all ages. For example, hydrocephalus ex-vacuo
occurs when there is damage to the brain caused by stroke or
traumatic injury. Normal pressure hydrocephalus occurs most often
among the elderly.
It may result from a subarachnoid hemorrhage, head trauma,
infection, tumor, or complications of surgery, although many
people develop normal pressure hydrocephalus without an obvious
cause. Symptoms of hydrocephalus vary with age, disease
progression, and individual differences in tolerance to CSF. In
infancy, the most obvious indication of hydrocephalus is often the
rapid increase in head circumstance or an unusually large head
size. In older children and adults, symptoms may include headache
followed by vomiting, nausea, papilledema (swelling of the optic
disk, which is part of the optic nerve), downward deviation of the
eyes (called "sunsetting"), problems with balance, poor
coordination, gait disturbance, urinary incontinence, slowing or
loss of development (in children), lethargy, drowsiness,
irritability, or other changes in personality or cognition,
including memory loss.
Hydrocephalus is diagnosed through clinical neurological
evaluation and by using cranial imaging techniques such as
ultrasonography, computer tomography (CT), magnetic resonance
imaging (MRI), or pressure-monitoring techniques.
Is there any treatment?
Hydrocephalus is most often treated with the surgical placement of
a shunt system. This system diverts the flow of CSF from a site
within the central nervous system to another area of the body
where it can be absorbed as part of the circulatory process. A
limited number of patients can be treated with an alternative
procedure called third ventriculostomy. In this procedure, a small
hole is made in the floor of the third ventricle, allowing the CSF
to bypass the obstruction and flow toward the site of resorption
around the surface of the brain.
What is the prognosis?
The prognosis for patients diagnosed with hydrocephalus is
difficult to predict, although there is some correlation between
the specific cause of hydrocephalus and the patient's outcome.
Prognosis is further complicated by the presence of associated
disorders, the timeliness of diagnosis, and the success of
treatment. The symptoms of normal pressure hydrocephalus usually
get worse over time if the condition is not treated, although some
people may experience temporary improvements. If left untreated,
progressive hydrocephalus is fatal, with rare exceptions. The
parents of children with hydrocephalus should be aware that
hydrocephalus poses risks to both cognitive and physical
development.
Treatment by an interdisciplinary team of medical professionals,
rehabilitation specialists, and educational experts is critical to
a positive outcome. Many children diagnosed with the disorder
benefit from rehabilitation therapies and educational
interventions, and go on to lead normal lives with few
limitations.
What research is being done?
The taj conducts and supports a wide range of fundamental studies
that explore the complex mechanisms of normal brain development.
The knowledge gained from these studies provides the foundation
for understanding how this process can go awry and, thus, offers
hope for new means to treat and prevent developmental brain
disorders such as congenital hydrocephalus.
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