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Hydrocephalus is an abnormal accumulation
of cerebrospinal fluid (CSF) within the normal CSF
cavities (ventricles) of the brain. This fluid, which
flows over the surface of the brain, is usually
reabsorbed by the body. Hydrocephalus occurs
either when a blockage within the brain prevents
flow of the CSF beyond the ventricles, or when the
absorption of fluid outside the brain is impaired,
thus resulting in a buildup of CSF in the ventricles,
which is visible on a brain MRI or CT scan.
Effective diagnosis and treatment require the
attention of expert neurologists and neurosurgeons
who have substantial experience with the disorder,
like those at the LifeBridge Health Brain &
Spine Institute.
Symptoms
Symptoms typically develop in patients over
60 years of age. At first, the symptoms of hydrocephalus may be subtle. They are characterized by
difficulty walking, memory loss, incontinence and
sometimes headache. Common signs and
symptoms of hydrocephalus include:
■ Problems with walking and balance,
shuffling, and falls or near-falls
■ Complaints of memory loss, mental
“fogginess” or slowing
■ Urinary urgency and incontinence
■ Headache or head fullness
Hydrocephalus produces different combinations of these symptoms, depending on its cause
and the age of the individual. For example, idiopathic normal pressure hydrocephalus (NPH),
which mainly affects older people, typically starts
with difficulty walking. Urinary incontinence often
develops, along with a type of dementia marked by
slowness of thinking and information processing.
Hydrocephalus in young and middle-aged adults
has more subtle manifestations of the same symptoms and includes difficulty with job performance
and multitasking, and there is often headache. Sometimes
the cause of hydrocephalus is known, such as head injury,
bleeding in or around the brain, or brain infection
(meningitis), but in most cases the cause is unknown.
Diagnosis
Doctors at the LifeBridge Health Brain & Spine
Institute Adult Hydrocephalus Center rely on a comprehensive medical history, examination and testing to diagnose hydrocephalus. Following a complete physical and
neurological examination, X-rays, a CT or MRI scan may
be recommended to provide detailed pictures of the
brain. Based upon the patient’s symptoms and results of
the brain scans, the neurologists at the Brain & Spine
Institute will develop a diagnosis and treatment plan to
meet each patient’s individual needs.
Diagnostic testing is done to identify those patients
in need of treatment; those who do not yet need treatment but may in the future; and those who are unlikely
to respond to treatment. The neurologists at the Adult
Hydrocephalus Center may recommend one of these
supplemental tests:
■ Lumbar puncture (spinal tap) for CSF removal
■ Insertion of a temporary spinal catheter for
CSF drainage or monitoring CSF pressure
■ Insertion of a temporary ventricular catheter
for CSF drainage or monitoring CSF pressure
(done in collaboration with neurosurgeons)
Treatment
The goal of treatment is to re-establish the balance
between CSF production and reabsorption. The most effective
treatment is surgical insertion of a shunt to divert the CSF
flow away from the brain to elsewhere in the body, where it
can be absorbed, such as the abdominal cavity. The neurologists and neurosurgeons of the Adult Hydrocephalus Center
collaborate to select the most appropriate surgical intervention for patients, including the use of programmable shunts
that can be adjusted non-invasively. There are no medications to treat hydrocephalus.
Continuity of Care
The treatment of hydrocephalus involves more
than the insertion of a shunt. Patients are evaluated
periodically to assess their response to treatment,
to adjust the shunt setting if necessary, or to determine the need for further tests or treatment. Initially
this may involve visits every few months; but later,
most patients are seen once or twice a year for
routine checkups.
Additional information is available from the
Hydrocephalus Association at www.hydroassoc.org
or by calling 888-598-3789.
Experience Matters
The Adult Hydrocephalus Center’s neurologists
are among the most experienced, published and
recognized experts regionally and nationally for
adult hydrocephalus.
For more information about adult hydrocephalus,
call the LifeBridge Health Brain & Spine Institute
at 1-888-747-8899.