Obstructive Hydrocephalus

What is Obstructive Hydrocephalus?

Hydrocephalus is commonly referred to as water on the brain (in Greek "hydro" means water and "cephalus" means head). Hydrocephalus is a condition in which there is an excessive accumulation of fluid within the skull. This fluid is not actual water; rather it's cerebrospinal fluid. The abnormal buildup of cerebrospinal fluid (CSF) can lead to pressure on the brain.

Cerebrospinal fluid (CSF) is a clear fluid that surrounds the spinal cord and brain. A few of the functions of CSF include acting as a shock absorber, transporting nutrients, removal of waste, and regulating pressure in the brain. The body continuously produces and absorbs CSF; therefore anything that affects either of these can lead to an imbalance. Also, anything that interrupts the normal flow of CSF can create its buildup and the resulting pressure on the brain.

An excess of pressure on the brain is potentially harmful; thus hydrocephalus can cause permanent brain damage and even death. However, with appropriate treatment, most patients are able to lead normal lives with few limitations.

Obstructive hydrocephalus can occur in patients of any age from infants to the elderly. Obstructive hydrocephalus is also known as non-communicating hydrocephalus. Here there's a blockage that prevents the flow of cerebrospinal fluid (CSF) between certain structures (ventricles) in the brain.

What are the Causes of Obstructive Hydrocephalus?

Obstructive hydrocephalus can be the result of any condition that blocks the flow of cerebrospinal fluid including:

  • Head trauma
  • Stroke
  • Bleeding or clots in the brain (e.g., subarachnoid hemorrhage)
  • Infections that affect the central nervous system (e.g., encephalitis or meningitis)
  • Central nervous system tumors (i.e., those affecting the brain or spinal cord)
  • Complications from surgery

What are the Symptoms of Obstructive Hydrocephalus?

Symptoms of hydrocephalus depend on: the cause of the cerebrospinal fluid buildup, the extent of any brain damage, and the patient's age.

Symptoms common in most patients (regardless of cause or age) may include:

  • Irritability
  • Nausea and/or vomiting
  • Headache
  • Seizures
  • Personality changes
  • Cognitive changes (e.g., problems with memory, the ability to think/reason, or difficulty paying attention).
  • Vision problems (e.g., blurry vision or uncontrolled eye movement)
  • Balance/coordination problems and/or difficulty walking (e.g., shuffling the feet or difficulty when starting to walk).

How is Obstructive Hydrocephalus Diagnosed?

A physician may perform following to diagnosis obstructive hydrocephalus:

  • Medical history: Discussing medical history (including head injuries & surgeries), current symptoms, and conditions/diseases that may affect the brain.
  • Physical and neurological examination: Assessing cognitive function, gait (walking) and balance.
  • Imaging studies: Patients suspected of having hydrocephalus will undergo imaging studies (MRI or CT scan) of their head.
  • Diagnostic procedures: Patients suspected of having hydrocephalus may also undergo a procedure to drain some cerebral spinal fluid. A lumbar puncture (spinal tap) will be required to accomplish this. The patient will be observed after the drainage to determine if their symptoms improve.

How is Hydrocephalus Treated?

Without treatment, symptoms often continue to get worse and can lead to death. Surgical treatment improves symptoms in many patients; however, not all patients see improvement in their symptoms. There is no way to accurately predict which patients will improve with surgery, although those with minimal symptoms generally have the best outcomes. If a patient's symptoms improve with cerebral spinal fluid drainage, then surgery is generally recommended.

There are several surgical procedures to treat hydrocephalus:

Removal of the obstruction: (e.g., brain tumor or blot clot) causing the accumulation of cerebrospinal fluid (CSF).

Ventricular shunt surgery: The goal of this procedure is to enable the excess CSF to flow out of the ventricle into another region of the body where it can be absorbed. A shunt (a thin, soft tube) is placed in the ventricle to accomplish this. The shunt has one-way valve that regulates the CSF flow.

Endoscopic third ventriculostomy: This is a minimally invasive procedure where the surgeon creates new pathway through which CSF can flow by making a small hole in bottom of a ventricle.

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