What is hydrocephalus?
The term “hydrocephalus” consists of two words: “hydro”, meaning water, and “cephalus”, meaning head. Hydrocephalus is a state in which an excess of cerebrospinal fluid (SPL) accumulates in the ventricles (cavities) of the brain and can lead to an excessive increase in pressure in the cavity of the skull. In fact, the cerebrospinal fluid that surrounds the brain and spine is normally present there always.
The cerebrospinal fluid has three major functions:
- CSF protects the brain tissue from injury when jolted or hit, by providing a fluid buffer that acts as a shock absorber from some forms of mechanical injury.
- CSF allows for regulation of the distribution of substances between cells of the brain, and neuroendocrine factors, to which slight changes can cause problems or damage to the nervous system.
- The prevention of brain ischemia is made by decreasing the amount of CSF in the limited space inside the skull. This decreases total intracranial pressure and facilitates blood perfusion.
An adult produces about 400 ml of cerebrospinal fluid a day and the same amount is absorbed by special structures in the coats of the brain. When a trauma or illness disrupts the regulation of the production, circulation or absorption of cerebrospinal fluid, one or more of the cerebral ventricles increase as the cerebrospinal fluid accumulates. In an adult, the skull is not able to change its size and cannot expand, so the pressure in the brain can grow very significantly.
Hydrocephalus is a chronic disease. It can be controlled, but it is usually impossible to cure definitively. However, with proper timely treatment, many elderly people with hydrocephalus live a perfectly normal life without serious limitations.
Hydrocephalus can be at any age, but is most common among infants and adults aged 60 years and older.
What types of hydrocephalus are existing?
1) Hydrocephalus ex-vacuo.
It develops when the brain is damaged as a result of a stroke or trauma, or the transferred neuro infections, and the volume of its tissue actually decreases. It is characteristic for elderly patients or those who are sick with Alzheimer’s disease. CSF fills the additional space formed as a result of a decrease in the volume of the brain tissue. In these cases, the ventricles increase, but the pressure is usually normal. But at the same time, the balance of the production and absorption of the SPL and ICP is disturbed.
2) Non-communicating hydrocephalus.
The ventricles of the brain increase as a result of the increased volume of cerebrospinal fluid, which compresses the brain and, ultimately, damages or destroys brain tissue. The ventricles inside the brain increase with even a slight increase in pressure. Occlusive hydrocephalus may develop as a result of trauma, neurosurgical intervention, hemorrhagic stroke, meningitis or tumor. Unfortunately, often the cause of occlussal hydrocephalus in the elderly is unknown, which makes it difficult to diagnose and develop a treatment plan. This is exacerbated by the fact that some of the symptoms of the disease are similar to the effects of the aging process, as well as diseases such as Alzheimer’s disease and Parkinson’s disease. The majority of the population over 60 years old, with hydrocephalus believe that their symptoms are only part of the aging process. Unfortunately, many cases are not diagnosed, and accordingly do not undergo proper treatment on time. Consequently, neither the patient nor relatives are often aware of this, and many general practitioners do not diagnose nonsensitive hydrocephalus of elderly people.
What are the main symptoms of hydrocephalus?
4)Changing personality and behavior
7) Less of the control of the pelvic organs
But the main three manifestations of hydrocephalus in the elderly are:
1. Decreased memory, later dementia or senile dementia with a gradual decrease in cognitive abilities, which affects the daily functioning of a person. Also, you can include symptoms like changes in emotional manifestations and a decrease in motivation, although this usually does not affect a person’s consciousness.
2. Problems whith the control of urination. This is an alarming problem that has a serious impact on the quality of life.
3. Movement disorders. The steps are typical for patients with hydrocephalus: broad, short, slow and shuffling. Patients may have problems with the onset of movement, as if their feet are glued to the ground. They may have difficulty moving up the stairs and often fall. Difficulties in walking can be the most obvious first symptom. These disorders vary in severity from moderate imbalance to inability to stand or walk at all.
Symptoms usually worsen over time and, if appropriate measures are not taken, they become irreversible.
What is treatment?
The problem can be directly eliminated if the outflow of cerebrospinal fluid is disturbed, for example, in the case of tumor compression by the outflow pathway of the SC, removal of the tumor or indirectly by switching the discharge of fluid to another location, usually in another body cavity. It is carried out by installing a device known as a shunt or fluid-shunting system (LHS), which directs the excess volume of CSF from the ventricles of the brain into the abdominal cavity. In some cases, two operations are performed, one of which reduces the pressure in the ventricles of the brain, and the other, at a later stage, to eliminate the cause of obstruction (for example, a brain tumor). After operation, the shunt usually remains in place throughout the life of the patient, although additional operations may be required as needed. With occlusive hydrocephalus, an alternative operation, called endoscopic triventriculostomy, may be recommended. During this operation, using an endoscope and micro-tools through a small hole in the skull, the surgeon makes a small hole in the bottom of the third ventricle, through which excess spinal fluid leaves.
What awaits after the operation?
If any symptoms and problems persist, it may take time and rehabilitation to further restore normal functioning. However, recovery may not be complete, especially with late seeking help. Periodic monitoring of the doctor is recommended to monitor the quality of shunt work. Post-operative check-up, including CT and X-ray, helps determine how the shunt works.
Immediately contact your doctor if you have any of the following symptoms:
1) Redness, pain or swelling of the skin along the length of the tube or incision on the head or abdomen.
2) Irritability or drowsiness
3) Nausea, vomiting, headache
4) Temperature rise
5) Pain in the abdomen
6) Return of neurologic symptoms
What is the prognosis?
Forecasts for hydrocephalus depend on the cause, extent of brain damage, symptoms and timeliness of diagnosis and treatment. Some patients demonstrate a fast restoring after treatment, while others do not. In some cases, dementia may regress gradually after shunting. Other symptoms, such as headaches, may disappear immediately if symptoms are associated with elevated ICP.
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