Hydrocephalous is a condition in which accumulation of cerebrospinal fluid occurs within the brain. This typically causes increase pressure inside the skull.
neural tube defects
Traumatic brain injuries
Clinical presentation of hydrocephalous varies with chronicity.
Focal nurological deficits may also occur, such as abducences nerve palsy and vertical gaze palsy (parinaud syndrome due to compression of the quadrigeminal plate,where the neural centers coordinating the conjugated vertical eye movement are located
Neural tube defect arachnoid cysts
The cause of hydrocephalus is not known with certainty and is probably multifactorial. It may be caused by impaired CSF flow, reabsorption, or excessive CSF production.
Hydrocephalus can be classified into communicating and noncommunicating (obstructive). Both forms can be either congenital or acquired.
communicating hydrocephalus, also known as nonobstructive hydrocephalus, is caused by impaired CSF reabsorption in the absence of any obstructive to CSF flow between the ventricles and subarchnoid space.
This may be due to functional impairement of the arachnoidal granulations), which are located along the superior sagittal sinus, and is the site of CSF reabsorption back into the venous system.
Non communicating hydrocephalus, or obstructive hydrocephalus is caused by a CSF- flow obstruction.
Normal pressure hydrocephalus When hydrocephalus occurs in adults, CSF levels rise but the amount of pressure is usually normal. It still causes the brain to swell and can lead to impaired functioning. In adults, this condition usually results from conditions that prevent CSF from flowing. However, in some cases, there is no known cause.
You might be at higher risk if you’ve experienced any of the following:
Hydrocephalus can cause permanent brain damage, so it’s important that you recognize symptoms of this condition and seek medical attention. The condition is more common in children, but it can affect people of any age.
Early signs of hydrocephalus in infants include:
Symptoms or signs that affect toddlers and older children include:
Symptoms in young and middle-aged adults include:
If you suspect that you or your child has hydrocephalus, your doctor will perform a physical exam to look for signs and symptoms. In children, doctors check for eyes that are sunken in, slow reflexes, a bulging fontanel, and a head circumference that is larger than normal for their age.
Your doctor may also use an ultrasound to get a closer look at the brain. These tests use high-frequency sound waves to create images of the brain. This type of ultrasound can only be done in babies whose fontanel (soft spot) is still open.
Magnetic resonance imaging (MRI) scans can be used to look for signs of excess CSF. MRIs use a magnetic field and radio waves to make a cross-sectional image of the brain.
Computerized tomography (CT) scans can also help diagnose hydrocephalus in children and adults. CT scans use several different X-rays to form a cross-sectional image of the brain. These scans can show enlarged brain ventricles that result from too much CSF.
Surgical treatments Hydrocephalus is treated with one of two surgical options:
Shunt systems generally function well but they can fail to properly drain the CSF due to mechanical failure or infection. When this happens the CSF once again begins to build up in the brain and earlier symptoms may recur. To reduce the buildup of CSF, the clogged shunt system is replaced to restore drainage of CSF. Shunts require monitoring and regular medical checkups. Multiple surgeries may be needed to repair or replace a shunt throughout a person’s lifetime. Seek medical help immediately if symptoms develop that suggest the shunt system is not working properly.
Signs and symptoms of shunt malfunction may include:
Many people diagnosed with hydrocephalus benefit from rehabilitation therapies and educational interventions. Treatment by an interdisciplinary team of medical professionals, rehabilitation specialists, and educational experts is critical to a positive outcome.
Supportive therapies for children may include:
Adults may also require similar support, including social workers, occupational therapists, and specialists in dementia care.
If left untreated, hydrocephalus can be fatal. Early diagnosis and successful treatment improve the chance for a good recovery.
With the benefits of surgery, rehabilitative therapies, and educational interventions, many people with hydrocephalus live relatively normal lives.
The symptoms of NPH usually get worse over time if the condition is not treated, although some people may experience temporary improvements.
While the success of treatment with shunts varies from person to person, some people recover almost completely after treatment and have a good quality of life.
Regardless of the different surgical management, children with hydrocephalus still have some disabilities. Therefore, early involvement with physiotherapists via different methods of rehabilitation is essential, whether surgical or non-surgical management is required. Additionally, successful shunting is usually related to more obvious and rapid improvements in rehabilitation efforts. Specific treatment procedures are numerous, functional training for activities of daily living; therapeutic exercise; manual techniques such as mobilization and stretching; and therapeutic modalities.
Physiotherapy goals are aimed at:
These goals should be achieved by: