Hydrocephalus; Causes, Signs and Symptoms, and Interventions
Hydrocephalus is a disturbance in cerebrospinal fluid (CSF) formation, flow or absorption leading to an increase in volume occupied by this fluid in the central nervous system (CNS). CSF is a clear and colourless fluid that is actively secreted by some cells in the CNS. This fluid surrounds the brain tissue as well as the spinal cord, protecting the CNS and making the tissues buoyant. Nourishes the neurons and facilitate the removal of metabolites and transport of hormones.
CSF is continuously produced, and it circulates around the brain and the spinal cord. However, it is reabsorbed at certain regions of the brain. This is to ensure that there is always a regulated amount around the brain. Hydrocephalus, however, is a disease involving CSF.
Causes
- Overproduction of CSF; a tumour of the CSF producing cells can result in overproduction leading to increase volume around the brain.
- Obstruction to the flow of CSF; CSF once produced, circulates from the site of production through spaces in the brain until it finally moves around the brain and the spinal cord. Any blockade along its path can cause hydrocephalus. For instance, brain tumours in regions along the path of the CSF can occlude the flow.
- Inadequate absorption of CSF; because CSF is continuously produced, it is also reabsorbed into the venous system to ensure only the needed amount is present around the brain. However, diseases affecting CSF reabsorption can cause accumulation around the brain hence hydrocephalus.
Signs and Symptoms
Clinical features of hydrocephalus are determined by the age of the patient, the cause, the duration and the manner of onset.
In infants.
- Head enlargement
- Bulging fontanelle
- Disjunction of sutures
- Vomiting
- Poor feeding
- Irritable
- Reduced activity
- Setting-sun sign (characteristic of increased intracranial pressure)
In children and adults.
- Unsteady gait
- Large head
- Vomiting
- Headache
- Drowsiness
- Neck pain
- Blurred vision
- Cognitive deterioration
Interventions
- Medical care
Medical interventions are used to delay surgical and definitive treatment.
- Medications can be used to decrease CSF production
- Medications can be used to enhance CSF absorption
- Surgical care
Surgical treatment is the preferred therapeutic option. There are a wide range of surgical procedures available to treat hydrocephalus depending on the cause and the age of the patient. The most used surgical approach is shunt placement. This involves creating an artificial path for the CSF to other areas in the body where it is absorbed into the venous system.