Hydrocephalus

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Hydrocephalus is a neurological condition where excess cerebrospinal fluid (CSF) builds up within the brain's ventricular system, causing increased pressure and swelling. This can damage brain tissues and lead to a variety of symptoms, depending on age and severity.

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🧠 WHAT IS CEREBROSPINAL FLUID (CSF)?

• A clear fluid that surrounds and cushions the brain and spinal cord

• Functions:

  • Protects brain from injury

  • Delivers nutrients

  • Removes waste

• Produced in the ventricles of the brain and normally reabsorbed into the bloodstream

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🔄 HOW HYDROCEPHALUS OCCURS

Hydrocephalus occurs when there’s:

1. Overproduction of CSF

2. Blocked flow within the ventricular system

3. Impaired reabsorption into the bloodstream

This leads to ventricle enlargement and increased intracranial pressure.

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📊 TYPES OF HYDROCEPHALUS

Type	Description	Common Causes
Communicating	CSF flows between ventricles but is not absorbed properly	Infection, hemorrhage
Non-communicating (Obstructive)	Blockage in the CSF pathway (e.g., aqueduct stenosis)	Tumor, cyst, congenital narrowing
Normal Pressure Hydrocephalus (NPH)	Ventricles enlarged, but pressure appears normal	Common in older adults
Congenital	Present at birth	Genetic, developmental malformations
Acquired	Develops later	Trauma, infections, brain tumors, hemorrhage

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👶 INFANT SYMPTOMS

• Rapid head growth

• Bulging fontanelle (soft spot)

• Downward gaze ("sunsetting" eyes)

• Irritability

• Poor feeding

• Seizures

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🧓 ADULT & OLDER CHILD SYMPTOMS

Area	Symptoms
Cognitive	Memory loss, confusion, dementia (especially in NPH)
Motor	Unsteady gait, difficulty walking, frequent falls
Urinary	Urinary incontinence
Visual	Blurred or double vision
Head	Chronic headaches, nausea, vomiting

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🧪 DIAGNOSIS

Test	Purpose
Ultrasound (infants)	Measures ventricle size via fontanelle
MRI/CT scan	Visualize enlarged ventricles, check for blockages
Lumbar puncture	Measures CSF pressure, test for infections
Neuropsychological testing	In suspected NPH cases

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💊 TREATMENTS FOR HYDROCEPHALUS

There is no cure, but surgical interventions can manage fluid buildup effectively.

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🔹 1. Shunt System (Most Common)

• A tube system surgically placed to drain excess CSF from the brain to another body part (usually the abdomen, called a VP shunt).

Part	Function
Catheter	Draws CSF from ventricles
Valve	Regulates flow to prevent overdrainage
Distal tubing	Carries CSF to absorption site (e.g., peritoneal cavity)

🔁 Lifelong monitoring is needed. Shunts may need revisions due to infection, blockage, or malfunction.

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🔹 2. Endoscopic Third Ventriculostomy (ETV)

• A minimally invasive surgery that creates an opening in the floor of the third ventricle to bypass obstruction.

• Effective in non-communicating hydrocephalus, especially in older children/adults.

• No implant needed.

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🔹 3. Choroid Plexus Cauterization (CPC)

• Sometimes used with ETV in infants.

• Involves cauterizing part of the choroid plexus (CSF-producing tissue) to reduce fluid production.

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🧘 SUPPORTIVE MANAGEMENT

• Physical and occupational therapy for mobility/balance

• Speech therapy (if developmental delays or speech affected)

• Educational support for children with learning difficulties

• Regular neurological evaluations

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🩺 PROGNOSIS

• With timely treatment, many patients lead normal lives.

• Untreated hydrocephalus can cause permanent brain damage, coma, or death.

• Early intervention, especially in children, greatly improves outcomes.