Hydrocephalus:

"Excessive cerebrospinal fluid (CSF) in the brain"

In Children

Signs and symptoms:

The early signs in children are
  • A large head, in comparison to body height and weight
  • Developmental delay, for example inablility to stand or walk steadily, or inability to speak
  • Poor vision, decreased alertness, and failure to thrive
  • Headaches, nausea and vomiting
Causes:

(1) Congenital - aqueduct stenosis

(2) Acquired - infection (meningitis or encephalitis), hemorrhage (stroke or trauma), tumour (brain or spinal tumour)

Investigations:
  • CT or MRI brain scan
  • Lumbar puncture
  • Eye examination


MRI brain scan showing dilated ventricles (hydrocephalus) on the left, and normal ventricles on the right.



MRI scan showing large posterior fossa cyst in Dandy-Walker syndrome.

Treatment:

(1) Insertion of Ventriculo-peritoneal shunt (VP shunt) - to divert CSF via a small tube, from the brain to the peritoneal cavity



CT scan showing shunt tubing within the lateral ventricle of the brain.

It will be connected to a valve which regulates the flow rate of the CSF.

Treatment:

(2) Endoscopic 3rd ventriculostomy. In certain cases, eg. Aqueduct stenosis, an internal opening in the floor of the 3rd ventricle, can be made, using a small endoscope (less than 2 mm diameter). This is an alternate pathway for CSF flow, and a shunt will not be needed.



An example of a Storz endoscope that can be used for ventriculostomy.



Picture showing the trajectory of the endoscope, the internal appearance of the ventricle and the ventriculostomy opening.

In Adults

Signs and symptoms:

The usual signs in adults are
  • Raised intracranial pressure, i.e. headaches, nausea, vomiting, reduced mental alertness
  • Poor vision or double vision, (from pressure on the optic nerve or the oculomotor nerves)
  • Unsteady walking and urinary incontinence (from the pressure on the cerebellum)
  • Dementia and memory loss (from pressure on the frontal lobes of the brain)
Causes:

(1) Infection (meningitis or encephalitis)
(2) Hemorrhage (from stroke, aneurysm, arteriovenous malformation)
(3) Brain tumour
(4) Idiopathic - "Normal pressure hydrocephalus” - usually from ageing

Investigations:
  • CT or MRI brain scan
  • Lumbar puncture
  • Eye examination
Treatment:

(1) Insertion of Ventriculo-peritoneal shunt (VP shunt) or Lumbar-peritoneal shunt (LP shunt) - to divert CSF via a small tube, from the brain or spine to the peritoneal cavity

(2) Endoscopic 3rd ventriculostomy - to create an internal CSF flow pathway.

Lumbar-peritoneal shunt; for communicating hydrocephalus.

Stroke Hydrocephalus Brain Tumour Arachnoid Cyst Spine Conditions (Adults) Spine Conditions (Children) Brain and Spinal Cord Tumors in Children




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