Hydrocephalus: Causes, Symptoms, and How to Treat It

Hydrocephalus is a condition where fluid builds up in the brain , causing increased pressure on the brain. The literal meaning of the disease is “water in the brain.”

Cerebrospinal fluid normally flows through the ventricles and bathes the brain and spine. If the pressure of the cerebrospinal fluid is too much, it can damage brain tissue and cause disturbances in brain function.

The function of cerebrospinal fluid is to keep the brain, which is heavy in volume, floating in the skull. Then, it is a brain cushion to prevent injury, remove metabolic waste in the brain, and maintain constant pressure in the brain. Precisely between the brain cavity and the spine to compensate for changes in blood pressure in the brain

This brain disorder has a big impact on the sufferer. Because it causes physical and intellectual development disorders. Not to mention, if the disease has serious complications.

Although it can affect all ages, hydrocephalus is common in adults and infants. Scientists note that 2 out of 1,000 babies are born with hydrocephalus.

Causes of Hydrocephalus

The following can cause hydrocephalus to occur:

A blockage occurs that prevents cerebrospinal fluid from flowing normally. There is a decrease in the ability of blood vessels to absorb it. The brain also produces excess fluid.

In some cases, this disease can also affect unborn babies. The causes are:

A birth defect in which the spine does not close. Genetic disorders The presence of certain infections that occur during pregnancy, for example the rubella virus 

Common causes in infants and toddlers are as follows:

Central nervous system infections such as meningitis , especially in infants Bleeding in the brain during or soon after delivery, especially in babies born prematurely Injuries that occur before, during, or after childbirth Head trauma Central nervous system tumors

In adults, hydrocephalus can occur if:

Infections involving the brain such as meningitis Head injury Bleeding from blood vessels in the brain Had brain surgery Signs or Symptoms of Hydrocephalus

Bayi normal (kiri) dan bayi dengan hidrosefalus (kanan). Sumber: cardinalglennon.com

In Babies An unusually large head and a very rapid increase in head size Bulging of the fontanelle, or soft spot on the surface of the skull Eyes that keep looking down Seizures Baby is experiencing extreme fussiness Vomit Excessive sleepiness Poor diet Muscle strength is very weak In Toddlers and Adults Headache Double or blurred vision Abnormal enlargement of the head Often sleepy Difficulty getting out of bed Nausea or vomiting Unstable body balance Poor coordination Decreased appetite Seizures Behavioral and Cognitive Changes in Toddlers and Adults Get angry quicker Behavioral changes Not focus Performance degradation Delays or problems with previously acquired abilities, such as walking or talking Types of Hydrocephalus

According to the National Health Service , there are 3 main types of hydrocephalus:

Congenital hydrocephalus 

Congenital hydrocephalus is when a baby is born with too much fluid in their brain. This can be caused by conditions such as spina bifida, or infections the mother had during pregnancy, such as mumps or rubella (German measles). Many babies born with hydrocephalus (congenital hydrocephalus) have permanent brain damage.

This can lead to several long-term complications, such as:

learning disability  speech problems memory problem short attention span problems with organizational skills vision problems, such as crossed eyes and vision loss problems with physical coordination epilepsy

If a child has a learning disability, they will need extra support from their nursery or school to ensure their needs are met.

Acquired hydrocephalus

Hydrocephalus that develops in children or adults. It usually develops after an illness or injury. For example, it may occur after a serious head injury or as a complication of a medical condition, such as a brain tumor .

Normal pressure hydrocephalus 

Normal pressure hydrocephalus ( NPH) is a rare and poorly understood condition that most often affects people over the age of 60. It can sometimes develop after an injury or stroke, but in most cases the cause is unknown.

Mobility problems, dementia and urinary incontinence are the main symptoms of NPH. But because these symptoms come on gradually and are similar to more common conditions, such as Alzheimer’s disease, NPH can be difficult to diagnose.

Diagnosis

The diagnosis of hydrocephalus is usually based on:

Your answers to your doctor’s questions about signs and symptoms General physical examination Neurological examination Brain imaging tests Neurological Examination

The type of neurological exam will depend on a person’s age. The neurologist may ask questions and perform relatively simple tests in the office to assess muscle tone, movement, well-being and how well the senses are functioning.

Brain Imaging

Imaging tests that can help diagnose hydrocephalus and identify the underlying cause of symptoms include:

USG

This test is often used for early assessment of infants because it is a relatively simple and low-risk procedure. The ultrasound device is placed over the soft spot (fontanel) on the top of the baby’s head. Ultrasound can also detect hydrocephalus before birth during routine prenatal screening.

MRI

This test uses radio waves and magnetic fields to produce detailed images of the brain. It is painless, but noisy and requires lying still.

MRI scans can show enlargement of the ventricles caused by excess cerebrospinal fluid. They can also be used to identify the cause of hydrocephalus or other conditions contributing to symptoms.

Children may need light sedation for some MRI scans. However, some hospitals use a fast version of MRI that generally does not require sedation.

CT scan

This special X-ray technology produces cross-sectional views of the brain. The scan is painless and quick. However, the test also requires lying still, so a child usually receives a mild sedative.

CT scans produce less detailed images than MRIs and cause a small amount of radiation exposure. However, it is important to note that CT scans for hydrocephalus are usually used only for emergency purposes.

Hydrocephalus Treatment

Hydrocephalus patients generally receive the following 3 treatments to treat their disease:

1. Shunt

A shunt is a method of inserting a long, flexible tube with a valve that allows fluid from the brain to flow in the right direction and at the right rate. One end of the tube is usually placed in one of the ventricles of the brain.

The tube then passes through a tunnel under the skin to another part of the body where the excess cerebrospinal fluid can be more easily absorbed by other organs, such as the abdomen or the space inside the liver.

People who have hydrocephalus usually need a shunt system for the rest of their lives. Patients will need regular monitoring.

2. Ventriculostomy

In this method, the surgeon will use a small video camera to get a direct view inside the brain and make a hole in the bottom of one of the ventricles or between the ventricles. The hole is to allow cerebrospinal fluid to drain from the brain.

The following team is needed to support healing in pediatric hydrocephalus patients: Pediatrician , who oversees the treatment plan and medical care. Pediatric neurologists, who specialize in the diagnosis and treatment of neurological disorders in children. Occupational therapists , who specialize in therapy to develop everyday skills. Developmental therapists, who specialize in therapy to help your child develop age-appropriate behavior, social skills and interpersonal skills. Mental health providers, such as psychologists or psychiatrists. Social workers or activists, who assist families with accessing services and planning for transitions in care. The aide teacher, who addresses learning disabilities, determines educational needs and identifies appropriate educational resources. Complications

In most cases, hydrocephalus can develop complications, including intellectual, developmental and physical disabilities, if left untreated. It can also be life-threatening. Less severe cases, if treated properly, may have few serious complications.

In addition, surgery used to treat hydrocephalus (excess fluid in the brain) can also cause complications. Both surgical procedures can cause complications. Shunt methods can stop the drainage of cerebrospinal fluid or poor regulation of the brain’s drainage system due to mechanical damage, blockage, or infection.

Complications of ventriculostomy include bleeding and infection. Any failure that occurs will cause complications.

Shunt problem

Shunts are delicate devices that can malfunction, usually due to blockage or infection. It is estimated that up to 4 out of 10 shunts will fail in the first year after surgery. Sometimes, scans after surgery show the shunt is not in the best position and further surgery is needed to reposition it.

If a baby or child has a shunt, the shunt may become too small as the child grows, and the shunt may need to be replaced. Since most people need a shunt for the rest of their lives, more than one replacement may be needed. Sometimes bleeding can occur when the shunt is positioned. This can cause nerve problems, such as weakness on one side. There is also a small risk of a fit after any type of brain surgery.

In younger children, especially infants, cerebrospinal fluid (CSF) may drain alongside the shunt rather than beneath it, and fluid may leak through the skin wound. Additional stitches may be needed to stop the leak.

Shunt blockage

A shunt blockage can be very serious because it can cause excess fluid to build up in the brain, which can lead to brain damage. This will cause symptoms of hydrocephalus. Emergency surgery will be needed to replace the malfunctioning shunt.

Shunt infection

Shunt infection is also a relatively common complication after shunt surgery. The risk of infection is up to 1 in 5 in children, with a lower risk in adults. Infection is more likely to develop during the first few months after surgery.

Symptoms of a shunt infection may include:

redness and tenderness along the shunt line high temperature headache vomit stiff neck stomach ache if the shunt goes into your stomach irritability or drowsiness in infants

Call your care team right away if you or your child has any of these symptoms.

Antibiotics may be needed to treat the infection and, in some cases, surgery may be needed to replace the shunt.

Complications of endoscopic third ventriculostomy (ETV)

Endoscopic third ventriculostomy (ETV) is an operation to create a small opening at the base of the brain to drain cerebrospinal fluid (CSF).

Possible complications after ETV surgery include:

the hole can be closed your brain may not be able to absorb the CSF that is now flowing through it You may experience an infection – although this is less likely than after shunt surgery. You may have bleeding inside the brain, this is usually minor.

If there are problems with the hole, you can repeat the procedure, or you may need to install a shunt.

Other risks of ETV include nerve problems, such as weakness on one side of the body, double vision or hormonal imbalances. Most nerve problems will get better, but there is a small risk of permanent problems. There is also a small risk of epilepsy, and a very small risk of blood vessel injury in the brain, which can be fatal.

Hydrocephalus Surgery Cost

The cost of hydrocephalus surgery itself can vary depending on the type of surgery performed, the severity of the hydrocephalus experienced, the medications used, and so on.

According to various sources, for shunt surgery (installing a thin tube into the brain to drain excess brain fluid) the cost generally ranges from Rp10,000,000 to Rp30,000,000. While for EVT (Endoscopic Third Ventriculostomy) surgery the cost starts from Rp15,000,000.

The cost of hydrocephalus surgery or brain fluid suction can be covered by BPJS Kesehatan. Therefore, Parents should take advantage of the facilities provided by the government.

Prevent Hydrocephalus

There are several things that can prevent children from getting hydrocephalus since in the womb. For example, vaccination before pregnancy related to various viruses that cause hydrocephalus, such as meningitis and rubella. The need for intensive care before giving birth which can cause premature birth .

In sports activities or driving a vehicle, try to make sure that the child uses a protective helmet to prevent head trauma when falling. In addition, the use of a car seat in a car with a tight seat belt can also prevent a hard blow to the head if an accident occurs while driving a car.

Of course, the support of family love and discipline in treatment will make the patient feel more comfortable and it will help the healing. Medical care for hydrocephalus patients can be very expensive, so parents must be prepared with insurance such as BPJS or other forms of insurance that can ease the costs.

When to See a Doctor?

Seek immediate medical care if your child has any of the following signs of complications:

Fever Irritability Drowsiness Nausea or vomiting Headache Stiff neck Having vision problems Redness of the skin, pain or tenderness of the skin along the path of the shunt tube Abdominal pain when the shunt valve is in the abdomen Recurrence of early hydrocephalus symptoms.

You should also contact your healthcare provider if:

The child has been diagnosed with hydrocephalus, and his condition is getting worse. You cannot care for your child at home. Popular Questions Regarding Hydrocephalus

The global incidence of hydrocephalus is 84.7 per 100,000 population. 3 to 4 babies out of 1,000 live births are estimated to have hydrocephalus.

In Indonesia itself, cases of hydrocephalus reach 10 per 1,000 live births. This case occurs most often in infants, with the number of cases reaching 46.25%. Male infants tend to experience this condition more often than female infants due to genetic factors.

The physical appearance of a child with hydrocephalus is generally worrying, so there may be many questions about this condition. Here are some popular questions related to hydrocephalus.

Is hydrocephalus dangerous?

Quoting from the official UCLA Health website , Hydrocephalus is a dangerous and serious condition, and even fatal if not treated properly.

Fifty percent of hydrocephalus patients who fail treatment will die. The other fifty percent will live with a condition called arrested hydrocephalus.

People with hydrocephalus who survive but do not receive treatment can suffer serious brain damage and physical disabilities.

The other half survive with what is called arrested hydrocephalus. Those who are not treated and survive may have serious brain damage and physical disabilities.

Is hydrocephalus survivable?

With proper care, babies with hydrocephalus can survive. However, they are at risk of experiencing various disorders such as impaired intelligence, memory, and vision. But it does not rule out the possibility of babies with hydrocephalus having normal intelligence.

When does hydrocephalus occur?

Hydrocephalus can occur either as a condition that is present at birth (congenital), or it can develop later in life. In some babies the condition is genetic, as in babies with congenital aqueductal stenosis. Other conditions, such as neural tube defects (such as spina bifida), are also associated with hydrocephalus.

Hydrocephalus is usually detected by prenatal ultrasound between 15 and 35 weeks of gestation.

Is hydrocephalus a hereditary disease?

Hydrocephalus can be inherited genetically, so congenital hydrocephalus can run in families. It is thought that congenital hydrocephalus is caused by a genetic disorder that can be passed down from one or both parents to a child.

Does hydrocephalus require surgery?

Hydrocephalus cannot be cured, babies born with congenital hydrocephalus will live with the condition. Surgery is needed to remove excess cerebrospinal fluid in the brain and prevent fatal risks such as brain damage or death.

How long does hydrocephalus surgery take?

The hydrocephalus surgery process usually lasts about 1 to 2 hours. While the post-operative recovery process varies between 3 and 4 days and is allowed to go home in about 1 week.

How much does hydrocephalus surgery cost?

The cost of hydrocephalus surgery varies depending on the severity of the disease, the type of surgery performed, and the hospital where the surgery is performed. However, in general, hydrocephalus surgery usually costs around Rp10,000,000 to Rp30,000,000.

All costs of hydrocephalus surgery are basically covered by BPJS Health in accordance with the Minister of Health Regulation (PMK) No. 28 of 2014.

Can a hydrocephalus head return to normal?

The baby’s skull bones are still not completely closed and anatomically there is an open empty space between the skull bones. In people with hydrocephalus, the head will enlarge due to the accumulation of fluid in the empty space.

If the excess fluid in the head has been removed, the baby’s head may return to its normal size and grow normally. Early intervention and proper treatment affect the size of the head of a person with hydrocephalus after surgery.

Can hydrocephalus cause death?

The accumulation of fluid in the skull is the cause of hydrocephalus. If not treated properly, bleeding in the brain can occur, causing blood clots to form and resulting in death.

Can hydrocephalus cause blindness?

Fluid buildup in the brain cavity can cause increased intracranial pressure and press on the brain, disrupting its function. Brain functions that play a role in regulating vision can also be disrupted.

If not treated immediately, the visual disturbances that occur can become permanent and cause blindness.

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That’s some information about hydrocephalus. The point is, if your child seems to experience some of these symptoms, consult a doctor immediately for medical help.

Hydrocephalus
https://www.mayoclinic.org/diseases-conditions/hydrocephalus/symptoms-causes/syc-20373604 

Hydrocephalus
https://medlineplus.gov/hydrocephalus.html 

Hydrocephalus
https://www.nhs.uk/conditions/hydrocephalus/ 

Republished with permission from theAsianParent Indonesia