Fluid Accumulation in the Brain – Hydrocephalus

Hydrocephalus is a neurological condition that causes increased intracranial pressure as a result of fluid accumulation in the cavities deep in the brain. Although it can occur at any age, it is most common in young infants and after the age of 60.

The brain and spinal cord are surrounded by a fluid called cerebrospinal fluid (CSF). CSF is produced deep in the brain in a place called the choroid plexus. It fills spaces in the brain called ventricles, from where it flows around the spinal cord and brain. It is reabsorbed from the part called arachnoid villi in the upper part of the brain and participates in the venous circulation. The brain almost floats inside the skull thanks to CSF. CSF surrounds the brain and spinal cord, absorbing shocks from movement. It takes the necessary nutrients from the blood and removes the waste products produced by the brain cells. Normally, there is 150 milliliters of cerebrospinal fluid in our body, that is, two-thirds of a glass of water. This amount may increase in hydrocephalus.

Hydrocephalus can occur for many reasons. It may be present at birth or may appear later.

Symptoms

Hydrocephalus in infants can cause abnormally large head, rapid increase in head circumference, and cambering in the fontanel region on the top of the head, where the bones have not yet closed. Symptoms such as vomiting, drowsiness, restlessness, malnutrition, seizures, downward fixation of the eyes, decrease in muscle tone and movements, and decreased response to tactile stimuli can be seen.

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In older children, hydrocephalus such as headache, blurred or double vision, fixation of gaze (sunset sign), drowsiness, nausea, vomiting, balance disorder, loss of appetite, seizure, urinary incontinence, personality change, decreased school performance, walking, speaking It can regress in abilities.

If hydrocephalus occurs in the young and middle-aged, there may be headache, confusion, balance and coordination disorder, loss of bladder control (incontinence, frequent urination, etc.), vision problems, cognitive skills such as memory, attention, and problem solving.

Hydrocephalus that occurs after the age of 60 can cause impaired bladder control, frequent urination, memory loss, progressive loss of thinking skills, gait disturbance, balance and coordination disorder.

What Causes Fluid Accumulation in the Brain?

The imbalance between produced and reabsorbed CSF causes hydrocephalus. It can be caused by overproduction, decreased absorption, or a blockage that impairs CSF flow. The most common cause is flow disruption (obstruction). Less frequently, impaired absorption and, most rarely, overproduction can lead to hydrocephalus.

CSF flow may be obstructed in newborns due to the defect in the development of the central nervous system. Bleeding within the ventricle may become obstructed in relation to premature (premature) delivery. Infections such as meningitis can impair reabsorption. Traumatic injuries to the brain can also cause hydrocephalus.

Diagnosis

Diagnosis is made by imaging methods based on complaints and findings. It can be detected in the womb and in small babies by ultrasonography. In older children and adults, computed tomography (CT) and magnetic resonance imaging (MRI) are used.

Treatment

The treatment is surgery. The most common method is to drain the excess fluid accumulated in the ventricles in the brain with a shunt. Generally, one end of the shunt is in the ventricle, the tube is advanced subcutaneously, and the other end is placed in the abdominal cavity (peritoneum) where excess fluid can be easily absorbed. This is called a ventriculoperitoneal (VP) shunt. In people with hydrocephalus, the shunt may need to remain for life. It is followed regularly.

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Another surgical technique is endoscopic third ventriculostomy. In this method, the inside of the brain is imaged with a small camera. CSF flow is provided by making a small hole in the floor of one of the ventricles or between the ventricles.

Physiotheraphy

People with hydrocephalus may also need physical therapy apart from surgery. If there is developmental delay in children, for example, if there is a delay in head holding, sitting, walking compared to normal, physical therapy should be performed. Adults can be rehabilitated to eliminate gait, balance and coordination disorders. In order to plan neurological rehabilitation , the patient should be examined by a physical therapy and rehabilitation doctor. If you want to make an appointment for an examination, you can reach us from the contact page.

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