Hydrocephalus

With the term hydrocephalus the accumulation of cerebrospinal fluid (or CSF) in the cerebral ventricles, which consequently increase in volume. The name of the pathology, deriving from the Greek, literally means "water in the head".

What is liquor used for?

Just like water is in fact the liquor, inside which the brain and spinal cord are immersed. This liquid plays a fundamental and multiple role:

  • protects the marrow and brain from possible trauma
  • it brings nutrients to the brain and eliminates harmful ones
  • balances the changes in intracranial and intravertebral pressure
hydrocephalus with ventricular dilation

Hydrocephalus: the causes

Common causes of hydrocephalus include: brain hemorrhages (linked to aneurysms), brain tumors, trauma, meningitis and infections, bleeding complications in premature babies. More rarely it can be considered a hereditary pathology, but it can be linked to pathologies of fetal development, such as spina bifida and encephalocele. The most affected subjects are children (congenital hydrocephalus) and adults over 60 (normotensive hydrocephalus)

Hydrocephalus and symptoms by age group

Symptoms of hydrocephalus vary depending on the patient's age:

  • neonate: abnormal increase in head circumference, tension and swelling of the fontanel, thin and tense skin of the head with prominent veins, separation between the bones of the skull, vomiting, irritability, downward gaze (sign of the setting sun), loss of appetite, drowsiness
  • child: abnormal increase in head circumference in the first year of life, headache, vomiting, nausea, fever, visual disturbances (double vision and decline), irritability, drowsiness, loss of balance and coordination, delay in walking and speech, lack of concentration, character disturbances, loss of sensory and motor functions, epileptic seizures, loss of appetite
  • young: headache, difficulty waking up and staying awake, lack of balance and coordination, urinary incontinence, visual disturbances, disabling cognitive disorders for the intellect and work activities
  • adult and elderly: walking disturbances, urinary incontinence, foot dragging, memory loss, dementia. The latter must be carefully investigated, as it is necessary to distinguish a symptom of normal pressure hydrocephalus from one of Alzheimer's disease.

Hydrocephalus: diagnosis and treatment

A thorough visit from your primary care physician and a complete neurological examination are the first steps in reaching a certain diagnosis of hydrocephalus. Consistent with the age range of the patient, the instrumental tests to be performed are ultrasound for the newborn, MRI of the brain for the child, CT or MRI of the brain for young, adult and elderly people. Treatment is identified according to the causes of hydrocephalus, the severity of the disease and the patient's condition. If hydrocephalus originates from a tumor or malformation, it can intervene directly on the cause. It is also possible drain the liquid elsewhere, through a valve, specially implanted just under the hair or behind the ear, e two catheters. This tool is constantly in operation and must remain there for life. Alternatively, you can perform a third-ventriculostomy: the operation, performed with the help of an endoscope that allows internal visualization, opens a new passage for the CSF on the floor of the third ventricle.

Healing and life expectancy

Immediately after any surgical operation, it is necessary to measure the neurological functions, making a comparison with those present in the pre-operative. If the disturbances persist, you can proceed with one specific rehabilitation. If the patient has been implanted with the drainage shunt, it is necessary constantly monitor the operation of the valve by CT or MRI of the brain, as needed check the placement of the catheters with x-ray and abdominal ultrasound. It is essential to contact your doctor promptly if you experience pain, redness, tension and swelling in the area where the incision was made or along the tube; drowsiness; irritability; fever; nausea; He retched; headache; double vision; pain in the abdomen; previously experienced neurological symptoms. In case of valve malfunction, which causes the symptoms of hydrocephalus to resume, it is possible to resort to a replacement, usually resolutive. The prognosis is strictly linked to the origins of hydrocephalus, symptoms and response to therapy. Consequentially, it is very difficult to make a prediction for the patient's recovery. The important element in this path is the timeliness, both in diagnosis and in treatment. If left untreated, unfortunately congenital hydrocephalus does not give a high life expectancy: about 4 years. 

Dr. François LECHANOINE

Senior Consultant Neurosurgeon, specialist in Cerebral, Vertebral minimally invasive and pediatric surgery, at the Maria Cecilia Hospital in Cotignola, the Piccole Figlie Hospital in Parma and the Domus Nova in Ravenna, highly specialized hospitals, accredited by the NHS and affiliated with most of the international insurance circuits .

Secretariat: open from Monday to Friday from 09:30 to 13:00 and from 15:00 to 18:00

 +348 916 3317

Studies: Milan, Rome, Naples, Caserta, Bari, Mola di Bari, Domegge di Cadore, Ravenna, Castrocaro Terme, Fermo.
 

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