The term hydrocephalus comes from two Latin words: hydro, meaning water, and cephalus, meaning head. Hydrocephalus describes an abnormal increase in the fluid that fills and floats the central nervous system (brain and spinal cord) under normal conditions. This fluid is known as cerebrospinal fluid (abbreviated as CRF).
Types of hydrocephalus
There are different types of hydrocephalus. Basically, they can be differentiated according to their occurrence:
- Acute or rapid-onset hydrocephalus: if it is within hours or days.
- Chronic hydrocephalus: when it arises slowly and progressively over days, weeks or months.
It can also be classified according to the existence of obstacles in the cerebrospinal fluid flow channels:
- Obstructive or non-communicating hydrocephalus, when there is an obstacle.
- Non-obstructive or communicating hydrocephalus, when there is no obstacle.
Symptoms of hydrocephalus
Neurosurgery specialists state that symptoms will depend on the type of hydrocephalus.
In those of rapid or acute presentation, the symptoms are usually striking and severe: headache that does not improve with regular medication, nausea, vomiting without previous nausea, tendency to sleep with difficulty staying awake, even epileptic seizures. If not treated quickly, it can progress to neurological coma and death.
In cases of chronic presentation, symptoms are usually less conspicuous and delayed in time, although progressive in intensity. For this reason, it may be difficult to detect or differentiate from other neurological diseases such as Parkinson’s or dementia, or other health problems in the elderly. Typically, the first symptom is usually a slow and progressive deterioration in gait, shuffling and splaying of the feet with instability and falls.
Subsequently, there is usually an inability to hold urine that progresses to incontinence and increasingly frequent memory lapses, clumsiness or absent-mindedness that progresses to dementia if the hydrocephalus is not treated.
What are the causes of hydrocephalus?
The causes of hydrocephalus are many and varied. Among them are tumors, cerebral hemorrhages, cerebral infections, cerebral radiotherapy, severe cranial trauma, cerebral malformations, such as Arnold-Chiari syndrome, etc. Sometimes children are already born with (congenital) hydrocephalus or develop it in infancy for one of these reasons or for no apparent reason.
Also, elderly patients or patients of a certain age begin to develop symptoms of chronic hydrocephalus, called normotensive hydrocephalus or chronic adult hydrocephalus, which is an important diagnosis to rule out as a treatable cause of dementia with a good prognosis (other causes of dementia are not treatable or do not have a good prognosis).
Treatment of hydrocephalus
It is a surgical treatment performed by the neurosurgeon. Depending on the type of hydrocephalus and its cause, one type of surgery or another will be required. The two basic ways to treat hydrocephalus are:
- Cerebrospinal fluid shunts, which in turn can be:
– External or temporary: external ventricular drains.
– Internal and definitive: these are known as ventriculo-peritoneal or lumbo-peritoneal shunts, fundamentally.
In these cases, an intracerebral tube is placed to provide an alternative outlet for the accumulated fluid to the outside of the body or to other parts of the body (peritoneum, atrium, etc.). It is usually performed in older patients and in hydrocephalus without evident obstruction to the flow of fluid.
- Endoscopic treatment or endoscopic premamillary ventriculostomy. By means of a cerebral endoscope, through a 14 mm hole in the skull, the cerebral ventricles where the fluid accumulates due to an obstruction are communicated with the floor of the brain, without the need to leave tubes or prostheses.
Are some people more prone to hemorrhage than others?
Yes. People who suffer hemorrhages, tumors, or brain infections; or the elderly with or without head trauma, but with symptoms of dementia and deterioration of their gait; should be closely monitored for having a higher frequency of presentation of hydrocephalus.