HYDROCEPHALUS Symptoms, Causes & Treatments OVERVIEW Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain. Cerebrospinal fluid normally flows through the ventricles and bathes the brain and spinal column. But the pressure of too much cerebrospinal fluid associated with hydrocephalus can damage brain tissues and cause a range of impairments in brain function. Hydrocephalus can happen at any age, but it occurs more frequently among infants and adults 60 and over. Surgical treatment for hydrocephalus can restore and maintain normal cerebrospinal fluid levels in the brain. Many different therapies are often required to manage symptoms or functional impairments resulting from hydrocephalus. SYMPTOMS The signs and symptoms of hydrocephalus vary somewhat by age of onset. Infants Common signs and symptoms of hydrocephalus in infants include: Changes in the head • An unusually large head • A rapid increase in the size of the head • A bulging or tense soft spot (fontanel) on the top of the head Physical signs and symptoms • Vomiting • Sleepiness • Irritability • Poor feeding • Seizures • Eyes fixed downward (sunsetting of the eyes) • Deficits in muscle tone and strength • Poor responsiveness to touch • Poor growth Toddlers and older children Among toddlers and older children, signs and symptoms may include: Physical signs and symptoms • Headache • Blurred or double vision • Eyes fixed downward (sunsetting of eyes) • Abnormal enlargement of a toddler's head • Sleepiness or lethargy • Nausea or vomiting • Unstable balance • Poor coordination • Poor appetite • Seizures • Urinary incontinence Behavioral and cognitive changes • Irritability • Change in personality • Decline in school performance • Delays or problems with previously acquired skills, such as walking or talking CAUSES Hydrocephalus is caused by an imbalance between how much cerebrospinal fluid is produced and how much is absorbed into the bloodstream. Cerebrospinal fluid is produced by tissues lining the ventricles of the brain. It flows through the ventricles by way of interconnecting channels. The fluid eventually flows into spaces around the brain and spinal column. It's absorbed primarily by blood vessels in tissues near the base of the brain. Cerebrospinal fluid plays an important role in brain function by: • Keeping the brain buoyant, allowing the relatively heavy brain to float within the skull • Cushioning the brain to prevent injury • Removing waste products of the brain's metabolism • Flowing back and forth between the brain cavity and spinal column to maintain a constant pressure within the brain — compensating for changes in blood pressure in the brain Excess cerebrospinal fluid in the ventricles occurs for one of the following reasons: Obstruction. The most common problem is a partial obstruction of the normal flow of cerebrospinal fluid, either from one ventricle to another or from the ventricles to other spaces around the brain. Poor absorption. Less common is a problem with the mechanisms that enable the blood vessels to absorb cerebrospinal fluid. This is often related to inflammation of brain tissues from disease or injury. Overproduction. Rarely, cerebrospinal fluid is created more quickly than it can be absorbed. TREATMENTS One of two surgical treatments may be used to treat hydrocephalus. Shunt The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate. One end of the tubing is usually placed in one of the brain's ventricles. The tubing is then tunneled under the skin to another part of the body where the excess cerebrospinal fluid can be more easily absorbed — such as the abdomen or a chamber in the heart. People who have hydrocephalus usually need a shunt system for the rest of their lives, and regular monitoring is required. Endoscopic third ventriculostomy Endoscopic third ventriculostomy is a surgical procedure that can be used for some people. In the procedure, your surgeon uses a small video camera to have direct vision inside the brain. Your surgeon makes a hole in the bottom of one of the ventricles or between the ventricles to enable cerebrospinal fluid to flow out of the brain. Complications of surgery Both surgical procedures can result in complications. Shunt systems can stop draining cerebrospinal fluid or poorly regulate drainage because of mechanical malfunctions, blockage or infections. Complications of ventriculostomy include bleeding and infections.