What is Hydrocephalus?
What is Hydrocephalus? Hydrocephalus is a buildup of fluid in the brain cavity or so-called ventricle. Which causes the ventricles in it to enlarge and suppress the organ. This fluid will continue to grow so that the ventricles in the brain enlarge and suppress the structure and surrounding brain tissue. If not treated immediately, this pressure can damage the tissues and weaken brain function.
Hydrocephalus can be suffered by all ages, but most cases occur in infants and the elderly. Based on the symptoms, hydrocephalus disease can be grouped into three types, namely:
- Congenital or congenital hydrocephalus. This condition occurs since the new baby is born. Infants who have congenital hydrocephalus, their heads will look very large. Their fontanels or fontanels will appear bulging and tightened. Because the baby’s scalp is still thin, the bubbles are making the veins become visible clearly. Infants with hydrocephalus, have eyes that look like they look down and the leg muscles look stiff, and susceptible to seizures. Other congenital hydrocephalus symptoms are easy drowsiness, nausea, fussiness, and insomnia.
- Hydrocephalus acquired or acquired. This condition is suffered by children and adults. In addition to the patient will experience nausea and neck pain, headache will also appear. This headache is usually felt in the morning, after waking up. Other symptoms of this type of hydrocephalus are drowsiness, blurred vision, confusion, difficulty in holding back or defecating, and difficulty walking. If not treated promptly, this condition can lead to coma, even death.
- Hydrocephalus with normal pressure. This condition is generally experienced by the elderly (above 60 years). Patients will have difficulty moving their legs, so some of them have to drag their feet to walk. Another symptom is the urge of urinary control that is characterized by difficulty holding back urination or often feel like urinating. In addition to physical, normal pressure hydrocephalus also affects the patient’s ability to think. They will be difficult to digest information and slow in responding to situations or questions.
Immediately check your baby, child, or yourself to see a doctor if you see or feel the symptoms of hydrocephalus. Especially in infants suffering from congenital hydrocephalus, if not treated properly, in the long run the condition can lead to complications such as:
- Co-ordination disorder.
- Impaired vision.
- Decreased memory.
- Difficulty learning.
- Speech disorder.
- Difficult to concentrate and attention easily distracted.
Causes of Hydrocephalus
In our brain there is a liquid called cerebrospinal. This fluid works to clean up waste that comes from brain metabolism, protect the brain from injury, keep the brain afloat in position, and prevent the occurrence of changes in pressure on the brain.
Each day the brain coating tissue routinely produces cerebrospinal fluid. The unused liquids are then removed from the body after being absorbed by the blood vessels.
Although beneficial to brain health, cerebrospinal fluid can backfire and turn to harm the brain when the amount of liquid produced is greater than the discharged. This is called hydrocephalus, which increases the volume of cerebrospinal fluid in the brain.
Some of the triggers of hydrocephalus include:
- Poor mechanism of fluid absorption due to inflammation or injury to the brain.
- Inhibition of cerebrospinal fluid flow due to abnormalities in the nervous system.
- Fetal infection while still in the womb causing inflammation in the fetal brain tissue.
- Bleeding in the brain.
- Brain tumor.
- Severe head injury.
- Stroke disease.
Diagnosis of Hydrocephalus
Several types of checks will be performed by a neurologist to diagnose hydrocephalus, such as physical signs checks, coordination and balance checks, sensory examination (seeing, hearing, or palpation), and examination of muscle conditions (tonus, strength, and reflexes). In addition, the patient’s psychological condition is also likely to be examined if necessary.
To confirm the buildup of cerebrospinal fluid in the brain or to determine whether other conditions are causing symptoms similar to hydrocephalus, the doctor may perform brain scans through:
- CT scan. Usually used as an emergency check against hydrocephalus disease. Through CT scan, cross-sectional brain images can be produced with X-ray technology.
- MRI scan. This examination aims to obtain detailed brain images using magnetic fields and radio waves.
- Ultrasound. This check is relatively safe and low risk. Therefore, ultrasound is often used as a preliminary examination to detect hydrocephalus in the fetus in the womb or the baby that has been born.
Treatment of Hydrocephalus
The main treatment of hydrocephalus is through surgery. The goal is to remove excess cerebrospinal fluid in the brain. One type of surgery usually applied to the case of hydrocephalus is a shunt-mounting operation.
Shunt is a special tool shaped hose paired by a surgeon into the head to drain brain fluid to other body parts and absorbed by blood vessels. Part of the body that is often selected as a route of cerebrospinal fluid flow is the abdominal cavity. Shunt is equipped with a valve that serves to control the flow of fluid so that the presence of cerebrospinal in the brain does not recede too quickly.
Shunts attached to infants and children generally need to be replaced as growth fits into their growing physicality. It is estimated that as many as two shunt installation procedures will be performed on children before they reach the age of 10 years.
Another type of hydrocephalus handling operation is endoscopic third ventriculostomy (ETV). In contrast to shunt mounting operations, in the ETV procedure, cerebrospinal fluid is removed by creating new absorption holes on the surface of the brain. This procedure is usually applied to cases of hydrocephalus triggered by brain ventricular blockage.
Side Effects of Hydrocephalus Treatment
The surgery proved effective in dealing with hydrocephalus. However, it is not possible this procedure can cause side effects in the future. In shunt installation operations, side effects are usually caused by damage or clogging of the device itself. This is a natural thing because shunt is a tool made of soft material that is vulnerable to obstacles.
The following are some of the side effects that can occur after undergoing a shunt installation procedure, including:
- Infection. This is relatively common, especially in the few months after surgery. Symptoms of post-shunt infection include nausea, headache, stiff neck, fever, and pain around the shunt lane. In children, they will often be drowsy or fussy. If the infection is not too severe, the doctor will usually only prescribe antibiotics. But if worried, shunt replacement operations will likely be needed.
- Shunt blockage. If the shunt is blocked, the cerebrospinal fluid can accumulate in the brain. This condition should be treated immediately because it can cause brain damage. In infants, side effects will be easily recognizable from the physical characteristics of a re-enlarged head. In addition to head enlargement, other symptoms of shunt blockage are nausea, headache, drowsiness, confusion, and the worst are coma. A damaged shunt replacement operation will usually be done as a solution.
Sometimes the shunts that are installed are not in the right position and of course this can cause problems. In children, especially infants, incorrect positioning of the shunt can make the cerebrospinal fluid seep into the side of the tube. If they have wounds on the skin, the fluid will come out through the wound. The positioning of the shunt inside the head should be done carefully. If not, can cause side effects, such as bleeding, nervous disorders, or seizures.
In addition to the shunt mounting operation, side effects may also occur after endoscopic third ventriculostomy (ETV) surgery. Some of these side effects include:
- Nerve problems include decreased function of one side of the body, hormone imbalance, double vision, or even epilepsy.
- Bleeding in the brain.
- Damage to the brain vessels.
- Brain failure to absorb cerebrospinal fluid.
- Close the absorption hole of cerebrospinal fluid.
In the case of closing back the absorption hole of cerebrospinal fluid that has been made, the doctor can handle it by doing ETV surgery again.
However, if ETV surgery still fails to treat hydrocephalus, it is likely that doctors will switch to shunt-mounting operations.