HYDROCEPHALUS: SYMPTOMS, CAUSES, TYPES, TREATMENT - NUTRITION - 2025

The hydrocephalus is condition where an excessive and abnormal accumulation of cerebrospinal fluid in the brain occurs. Cerebrospinal fluid (CSF) works by protecting and cushioning the brain and its structures, and is constantly produced and absorbed. Hydrocephalus occurs when an imbalance develops between production and absorption or elimination.

The excessive accumulation of fluid causes, specifically, the cerebral ventricles to expand. As a result, the widening will generate pressure on other structures causing serious damage, so extensive neurological symptoms may occur.

Hydrocephalus can affect a large number of people, from newborns, older children, adults, to the elderly or elderly. In addition, it can have various causes, both acquired and generated before birth.

Currently, hydrocephalus is a neurological disease that is treated through the use of a surgical procedure. It is a relatively common intervention, in which the passage of cerebrospinal fluid is channeled to another place in the body.

Although neurological complications may appear, in most cases therapeutic procedures tend to cure the disease, although there are occasions when hydrocephalus can remain chronic.

Features of hydrocephalus

The word hydrocephalus comes from the Greek terms 'Hydro' which means water and 'cephali' which means head. Since ancient times, this pathology has been identified with an accumulation or collection of fluid at the brain level.

Currently, we know that hydrocephalus is an accumulation of cerebrospinal fluid in the brain cavities, in the cerebral ventricles. The excess fluid increases the size of the ventricles and puts pressure on the different brain structures.

Our body produces approximately half a liter of CSF on a daily basis and is constantly replacing it. Under normal conditions, there is a fine balance between the amount produced and the amount absorbed.

There are many factors that can alter the balance of the CSF, and therefore cause an abnormal accumulation of CSF.

Depending on the brain structures that are affected by the obstruction and pressure, various complications and neurological manifestations will appear at the clinical level: headache, vomiting, psychomotor retardation, macrocephaly, strabismus, among others.

Statistics

Hydrocephalus generally occurs more frequently in children and adults over 60 years of age.

Although there is not a large volume of statistical data on the incidence and prevalence of hydrocephalus, it is estimated that in the case of children, this pathology can affect 1 in 500.

Currently, most cases of infantile hydrocephalus are diagnosed in the prenatal phase, at birth or in the first years of life (National Institute of Neurological.

Symptoms

Depending on the nerve structures that are affected by hydrocephalus, the symptoms may change considerably between people who suffer from it. Despite this, the Mayo Clinic points out some of the most common symptoms:

Physical symptoms

- Variable headache, headaches.

- Blurred or double vision (diplopia).

- Normally elevated cranial volume (Macrocephaly).

- Drowsiness.

- Difficulty waking up or staying in a waking state.

- Nausea and vomiting.

- Coordination difficulty.

- Unstable balance.

- Loss of appetite.

- convulsive episodes.

Cognitive and behavioral changes

- Difficulty maintaining attention and concentration.

- Psychomotor retardation.

- Difficulties and forgetfulness in previously acquired skills (walking, speaking, etc).

- Irritability.

- Changes in personality traits.

- Decrease in school / work performance.

As for the age and the symptoms related to the different groups, we can highlight.

Most common symptoms in young and middle-aged adults

- Inability or serious difficulties to stay awake.

- Significant loss of balance and motor coordination.

- Loss of sphincter control.

- Vision difficulties.

- Deficits in memory, concentration and other skills that can affect routine functional performance.

Most common symptoms in adults 60 years of age or older

- Loss of sphincter control or a recurring urge to urinate.

- More severe memory deficits.

- Progressive loss of reasoning and problem solving skills.

- Difficulty walking (shuffling, feeling of immobility of the feet, poor balance, etc).

- Reduction of the speed of execution of movements.

In the case of infants and young children, the following symptoms will be considered as serious indicators of hydrocephalus:

- Recurrent vomiting.

- Inability to perform voluntary movements with the neck or head.

- Breathing difficulties.

- convulsive episodes.

- Suction and feeding difficulties.

Types of hydrocephalus

Throughout the medical and scientific literature we can identify some terms that have been used to distinguish between different types of hydrocephalus (Chauvet and Boch, X):

External hydrocephalus

Enlargement of the frontal subarachnoid space, with a normal ventricular volume and without clinical results or repercussions.

Hydrocephalus ex vacuo

It is an increase in the volume of the ventricles with a reduction in the brain gray matter, it is possible to observe it in elderly people and it does not have to be the result of hydrocephalus.

Interrupted hydrocephalus

It is hydrocephalus that occurs as a consequence of a dysfunction in the balance of the reabsorption mechanisms. It usually presents a localized ventricular dilation without the development of significant symptoms.

Communicating / non-communicating hydrocephalus

It is a hydrocephalus that occurs as a result of the presence of an obstruction in the flow of cerebrospinal fluid. In the case of the communicator, the obstacle is in the arachnoid villi (choroid plexus) and in the non-communicator the obstacle is proximal.

Congenital hydrocephalus

This type of hydrocephalus is already present at birth and is the product of events or influences that take place during embryonic development.

Acquired hydrocephalus

This type of hydrocephalus can develop at birth or later. In addition, it can affect people of any age and is caused by different types of pathologies and / or injuries.

Causes

Hydrocephalus, as we have defined previously, occurs as a consequence of an excessive accumulation of cerebrospinal fluid and this may be due to:

Obstruction

Cerebrospinal flow obstruction is one of the most common problems, both from one ventricle to another or between it and the rest of the pathways.

Poor absorption

Deficits in cerebrospinal fluid reabsorption mechanisms are less frequent. They are normally associated with inflammation of tissues due to various injuries or diseases at the brain level.

Overproduction

On some occasions, although rare, the mechanisms responsible for the production of cerebrospinal fluid can produce high amounts of it and more quickly than it can be absorbed.

There are a wide variety of medical conditions that can lead to the development of both an obstruction, poor absorption or overproduction of cerebrospinal fluid. Some of the most common medical problems are:

- Aqueductal obstruction (stenosis): this is the most common cause of congenital hydrocephalus in which there is an obstruction of the passageway that communicates the third with the fourth ventricle. Infections, bleeding, or tumors can cause the aqueduct to narrow or block.

- Spina bifida: spina bifida is a pathology in which there is a defect in the closure of the spinal canal and the vertebrae that surround it. In a high percentage of cases, children with spina bifida develop Chiari Syndrome Type II, a brain malformation that causes a blockage of the flow of cerebrospinal fluid.

- Intraventricular hemorrhage: intraventricular hemorrhages are one of the causes that can lead to the development of acquired hydrocephalus and occurs when there is a rupture of the blood vessels that extend through the ventricular tissue. The pool of blood can plug and block the passage of cerebrospinal fluid.

- Meningitis: meningitis is a type of pathology in which there is a serious inflammation of the membranes that cover the brain and spinal cord. The action of different viruses or bacteria can cause scarring of different areas of the meninges and therefore restrict the passage of cerebrospinal fluid through the subarachnoid space.

- Head trauma: Like other conditions, a trauma or blow to the skull can damage nerve tissues. When this occurs, blood or inflammation in these tissues can both enter and compress the CSF flow pathways.

- Tumors: tumors that spread to or reach the brain can compress both the cerebral ventricles and the adjacent areas, blocking the passage of brain and spinal fluid.

- Arachnoid cysts: arachnoid cysts are one of the congenital causes and although they can appear in any part of the brain, in children they are more common in the posterior region and the third ventricles. Cysts develop as sacs filled with cerebrospinal fluid covered by the arachnoid membrane and therefore, this formation can block the ventricular passageways.

- Dandy Walker syndrome: in Dandy Walker syndrome, various brain abnormalities can appear, among which are a widening of the fourth ventricle and / or obstruction of the aqueduct of Sylvius, therefore the flow systems of cerebrospinal fluid can also be interrupted.

Diagnosis

Due to the fact that different factors or etiologies can lead to the development of problems related to hydrocephalus, an accurate diagnosis is essential.

As in other neurological pathologies, the general diagnosis of hydrocephalus is based on:

- Anamnesis

- Physical examination

- Neurological examination

- Brain imaging tests: magnetic resonance, computerized tomography, ultrasound (in the prenatal stage).

Treatment

The most common treatment for hydrocephalus is surgical intervention through a bypass procedure.

The use of a bypass system consists of the placement of a tube, catheter or valve that redirects the flow of cerebrospinal fluid from the central nervous system to another area of ​​the body where it can be reabsorbed.

Specifically, one end of the catheter is placed in the central nervous system, within the cerebral ventricle, cyst, or area near the spinal cord. The other end is commonly implanted in the abdominal area, within the peritoneal cavity.

A valve located along the catheter is in charge of controlling and maintaining the direction and quantity of cerebrospinal flow to be reabsorbed.

Although they tend to work in most situations, bypass systems are flawed. Mechanical failures, infections, obstructions, etc. may appear.

References

1. Chauvet, D., & Boch, AL (2015). Hydrocephalus Treaty of Medicine.
2. HE HAS. (2016). Hydrocephalus. Obtained from Hydrocepahlus Association.
3. hydrocephaluskid. (2009). About Hydrocephalus. Obtained from Pediatric Hydrocephalus Foundation.
4. Malagón-Valdez. (2006). Congenital hydrocephalus. Neonatology Neurology Symposium, 39-44.
5. NHF. (2014). National Hydrocepahlus Foundation. Obtained from Hydrocephalus defined.
6. NIH. (2014). Hydrocephalus Fact Sheet. Obtained from National Institute of Neurological Disorders and Stroke.
7. Puche Mira, A. (2008). Hydrocephalus- Ventricular collapse syndrome. Therapeutic Diagnostic Protocols of the AEP. Pediatric Neurology.