spina bifida cure | What is Hydrocephalus, from infants to the elderly, treatment, has a cure?

What is Hydrocephalus, from infants to the elderly, treatment, has a cure?



Hydrocephalus is the accumulation of cerebrospinal fluid (CSF or CSF) in the cranial ventricular cavities, causing increased intracranial pressure on the brain, which can lead to damage to the brain tissue, as well as increased and swollen skull.

Cerebrospinal fluid is a fluid that bathes the brain and spinal cord in order to avoid any trauma or shock to the central nervous system. It is produced and absorbed by the ventricles located in the person's skull through the bloodstream, but when there are obstructions in the small holes through which it circulates, the process can be hampered.
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In addition to this function of protecting the brain and spinal cord, CSF has two other:

    It acts as a vehicle to supply nutrients to the brain and also to remove residues from the brain;
    Compensate for changes in intracranial blood volume between the skull and spine.

With regard to epidemiology, hydrocephalus affects around 1 to 3 people per 1000 births. In addition, 60% of the cases affect newborns and, 40%, the elderly, being the male group with a higher developmental propensity.
Index in this article you will find the following information:

    What is Hydrocephalus
    Types and Causes
    Symptoms of Hydrocephalus
    Risk factors
    Diagnosis
    Does Hydrocephalus Cure? What is the treatment?
    Complications
    Living together
    Prevention

Types and Causes

Hydrocephalus can be classified into 3 different types and for this it will depend on its cause. The condition ratings are:

    Obstructive (non-communicating): when there is a blockage that prevents the CSF from flowing normally;
    Non-obstructive (communicating): is the result of an excessive increase in CSF (rare cases) or of a decreased ability of blood vessels to absorb CSF;
    Normal (communicating) pressure is a type of hydrocephalus that affects adults, especially the elderly, and intracranial pressure often does not increase even if CSF levels are elevated. It may be the result of trauma or illness, but the concrete causes of this type are not yet known.

Obstructive

CSF flow obstruction may be caused by the following situations:

    The obstruction of the foramen monro can lead to dilation of one or both lateral ventricles;
    The Sylvius aqueduct (cerebral aqueduct) can be obstructed by several genetically acquired lesions (such as hemorrhages and tumors), leading to dilation of both lateral ventricles, as well as the third ventricle;
    When the fourth ventricle is obstructed, it dilates the lateral ventricles and also the third;
    The Luschka and Magendie Forams may be obstructed by a congenital opening defect.

Non-obstructive

Caused by reabsorption of CSF without any obstruction between the flow of fluid and the ventricles of the skull, this hydrocephalus can be caused by:

    Infections in the central nervous system, such as meningitis;
    Cerebral hemorrhage during or shortly after delivery, especially in premature infants;
    Injuries that occur before, during, or after delivery;
    Head trauma;
    Tumors located in the central nervous system.

Normal pressure

Usually, the cause of this is something that prevents the correct flow of CSF into the bloodstream. You will be more likely to develop it if you have experienced any of these:
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    Brain infections, such as meningitis;
    Head injuries;
    Bleeding from some blood vessel in your brain;
    Brain surgery.

Symptoms of Hydrocephalus

Because hydrocephalus can happen to anyone and at any age - the symptoms vary depending on the patient's age group.
Symptoms in Babies

The most common symptoms of the condition in babies are:
Head change

    An unusual and rapid increase in head;
    A more prominent spot on the top of the head (fontanelle or millstone).

Physical symptoms

    Vomiting;
    Somnolence;
    Irritability;
    Deficiency in food;
    Convulsions;
    Shrinkage of eyes (stare down);
    Deficits in tone and muscle strength, as well as in your expected growth.

Symptoms in young children and older children

In this age group, the most common symptoms are:
Physical symptoms

    Headache;
    Blurry or double vision.

Physical signs

    Abnormal head enlargement;
    Somnolence;
    Difficulty in waking or staying awake;
    Nausea or vomiting;
    Unstable equilibrium;
    Poor coordination;
    Little appetite;
    Convulsions.

Cognitive and behavioral changes

    Irritability;
    Change in personality;
    Attention problems;
    Decline in school performance;
    Delays or problems with previously acquired skills such as speaking or walking.

Symptoms in young and middle-aged adults

The most recurrent symptoms at this stage are:

    Headache;
    Difficulty in waking or staying awake;
    Loss of coordination and balance;
    Urinary incontinence;
    Vision impaired;
    Deficit in attention, concentration and other skills that involve thinking.

Symptoms in the elderly

Among adults over 60 years of age, the symptoms that characterize hydrocephalus are:

    Urinary incontinence;
    Loss of memory and other skills related to thinking or reasoning;
    Difficulty in walking (crawling or feeling of feet being trapped);
    Poor coordination or balance;
    Slowness in movements.

It is necessary to be aware of these symptoms, because, in this age group, hydrocephalus is confused with other disorders, such as Parkinson's disease and Alzheimer's.
Risk factors

In most cases, the exact cause for the development of the condition is not known. However, it is known that some environmental or medical events may contribute to the onset of hydrocephalus.
Newborns

    Abnormal development of the central nervous system, which can obstruct CSF flow;
    Incomplete closure of the neural tube, also known as spina bifida;
    Hemorrhage within the ventricles, possible complication of preterm birth;
    Infection in the uterus during pregnancy, such as rubella or syphilis.


Other factors

    Injuries or tumors in the brain or spinal cord;
    Infections of the central nervous system, such as bacterial meningitis or mumps;
    Bleeding in the brain due to a stroke or head injury;
    Other traumatic brain injuries.

Diagnosis

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The diagnosis for hydrocephalus is divided into two types and both are performed by the neurologist. First, a clinical neurological examination is done and, after them, imaging of the brain is requested.

Understand each one better:
Neurological examination

As each age group presents different symptoms of the disease, this neurological examination will also be different for each one. In addition to questions, your doctor will do simple tests such as:

Muscle conditions

    Reflexes;
    Strength and muscle tone.

Sensory state

    Sense of touch;
    Vision and eye movement;
    Hearing.

State of the movement

    Coordination;
    Balance.

Psychiatric condition

    Mental state;
    Humor.

Image exams

If the specialist continues with suspected hydrocephalus even after these clinical trials, imaging of the brain may be requested. They are:
Computed tomography

An exam that evaluates the size of the ventricles and other structures of the brain.
Magnetic Resonance Imaging

Evaluates Chiari malformation (a condition in which the brain tissue extends into the spinal canal) or cerebellar or periaquedutatic tumors.
Ultrasonography in infants

This test is needed to see if there is intraventricular hemorrhage. In addition, it also checks for possible progressive hydrocephalus.
Radiography of skull

It detects possible erosions in the skull, like that of the turcica saddle.
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Magnetic resonance imaging

It measures the volume of cerebrospinal fluid in the cerebral aqueduct.
Image of diffusion tensor

An examination that allows the recognition of microstructural changes in the region of the white matter (set of cells that has the function of supporting, sustaining, electrically isolating or nourishing the neurons and ganglia) periventricular.
Does Hydrocephalus Cure? What is the treatment?

Because hydrocephalus does not have a definitive cure, the treatments available for the condition serve to control it. Usually these treatments are followed up by a neurologist and should be done as soon as possible so that sequelae can be avoided.

It is estimated that each year 140,000 people are treated for hydrocephalus, which can be in the following ways:
Ventricular-Peritoneal Derivation (DVP)


ways:
Ventricular-Peritoneal Derivation (DVP)

It consists of the implantation of a valve, through surgery, that will drain the CSF into the peritoneum (abdominal cavity) or into the heart (right atrium), since the brain can not perform the function. As this procedure can have consequences such as catheter obstruction or infection, Professor Maurice Choux of the city of Marseilles (France) recommends that these surgeries be the first one in the morning and that no more than three surgeries of the type be done in a single day .
Neuroendoscopy

Neuroendoscopy is performed from the introduction of a very fine device (endoscope) through a hole made in the skull. When this is done, the endoscope travels through the cerebral ventricles and, with the opening of the floor of the third ventricle, CSF can circulate normally between the ventricular system and the subarachnoid space.
Intrauterine treatment

Ultrasound can now detect the disease in the baby from the 16th week of gestation, and by the 24th week, surgery on the fetus can be performed, still inside the mother's belly. Through this surgery, doctors puncture the baby's ventricle to remove excess CSF or install a catheter that diverts it to the amniotic fluid. With the child's birth, this catheter is removed, replacing it with the bypass system.

This type of treatment is only indicated in cases that are not caused by chromosomal changes or infectious diseases.
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Medicines

Some medicines may be used to reduce CSF production, such as Acetazolamide or Furosemide. It is important to emphasize that its use is not effective in the long term, but serves to temporarily postpone a surgical procedure.

Attention!

NEVER self-medicate or stop using a medicine without first consulting a doctor. Only he can tell which medication, dosage and duration of treatment is most appropriate for your specific case. The information contained on this site is for informational purposes only and is not intended to replace a specialist's advice or to serve as a recommendation for any type of treatment. Always follow the directions on the package leaflet and, if symptoms persist, seek medical or pharmaceutical advice.
Complications

When not treated properly, hydrocephalus can cause the death of the patient, usually due to a secondary tonsillar hernia. In addition, as already mentioned, DVP complications may arise, in addition to the consequences that the disease brings to the patient's health.
Consequences of DVP

Placement of the valve in a patient suffering from hydrocephalus can bring several complications, which can be divided into mechanical and biological:

    Mechanical complications: related to obstruction of catheters, obstruction of the valve or rupture of the material from which it is made;
    Biological complications: the most frequent complications of this type are infections, which can lead to meningitis, ventriculitis, peritonitis or endocarditis.

With regard to infections, according to the literature, the incidence is higher in the first year after placement of the valve ranges from 0.5 to 15% chance. Regarding the operation of the device, it is estimated that 30% of those who were implanted stopped working in the first year.

Still, some of these complications can lead to other problems, such as excessive CSF drainage or under-drainage:

    Excess drainage: occurs when the valve allows the CSF to drain out of the ventricles more quickly than it is produced. This causes the ventricles to collapse, tearing the blood vessels and causing headache, hemorrhaging, and slit ventricles.
    Sub-drainage: In this case, the CSF is not absorbed rapidly and causes the symptoms of hydrocephalus to reappear.


Consequences of hydrocephalus

The sooner you are diagnosed, the better the treatment for hydrocephalus. This is due to the fact that, when not treated properly, the condition can generate sequelae when the brain tissue is affected intensely. Among these sequels, there may be:
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    Problems in mental and / or motor development;
    Difficulties in learning and reasoning;
    Difficulties in speech;
    Difficulty walking.

When the case is very severe, hydrocephalus can also cause irreparable damage to the brain, such as mental retardation or paralysis, as well as death. In addition, one in four patients develops epilepsy due to the condition.

It is known that eye problems can also occur, since the increase of intracranial pressure in the patient is transmitted to the optic nerves, which can generate optic papilla edema. When hydrocephalus is not properly treated, this edema may develop into blindness. Therefore, at the sign of any change in vision, it is best to seek the medical help of an ophthalmologist.
Living together

It should be borne in mind that patients suffering from hydrocephalus may have difficulties in cognitive and physical development. However, many of them benefit from therapies performed by an interdisciplinary team of doctors, rehabilitation specialists, and education specialists.
Caring for children

    Pediatrician or Physiatrist: oversees the treatment plan and medical care;
    Pediatric neurologist: doctor specializing in the diagnosis of brain disorders in children;
    Occupational therapist: develops therapies that will aid in the development of everyday skills;
    Developmental therapist: Helps the child develop behaviors consistent with his or her age, as well as social and interpersonal skills;
    Psychologist or psychiatrist: verifies the mental health of the patient;
    Social worker: helps the family with the reality lived;
    Special education teacher: addresses learning difficulties, determines needs in education, and identifies the most appropriate educational resources.

Care for adults

Because adults may have more severe complications, they need the help of the following specialists:

    Occupational Therapist;
    Social worker;
    Specialist in dementia care, due to memory loss and other functions that are related to thinking.

Prevention

Hydrocephalus can not be prevented, but some precautions may help prevent the condition from developing.
Prenatal care in pregnancy

Taking proper care during pregnancy reduces the chance of preterm labor, which can cause hydrocephalus.
Vaccination

Infectious diseases that can cause hydrocephalus should be prevented through vaccination.
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Use of safety equipment

Prevent head injuries from occurring, so always use safety equipment, such as helmets and seat belts. In addition, make sure that the car seat is properly installed, as it can also prevent injuries to the baby's head.

Because hydrocephalus is a condition that can affect people of any age, it is important to be alert to the signs that it can lead to. Share this article with your friends and acquaintances and make the information presented here reach out to more people!