Hydrocephalus is a brain condition that occurs when cerebrospinal fluid (CSF)– the clear, watery fluid that surrounds and cushions the brain and spine– can not drain from the brain. It then swimming pools, triggering an accumulation of fluid in the skull. Hydrocephalus gets its name from the Greek words for water (hydro) and head (cephalus), and often is called “water on the brain.”
Hydrocephalus can cause babies’ and kids’s visit swell to make space for the excess fluid. Older kids, whose skull bones have actually matured and merged together, have painful headaches from the increased pressure in the head.
If it’s not dealt with, hydrocephalus can lead to mental retardation, a loss in mental and physical capabilities, and even death. With early medical diagnosis and timely treatment, however, many children recuperate effectively.
Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain.
Causes of Hydrocephalus in Infants
When whatever is working usually inside the brain, CSF flows through narrow passages called ventricles and exits the brain through a small reservoir at the base of the brain called the cistern. CSF delivers nutrients to the brain; it likewise takes run out from its delicate areas to be taken in into the blood stream.
If there’s an obstruction in any of the ventricles, CSF backs up and causes hydrocephalus. This excess of fluid in the brain likewise can take place when the choroid plexus (the area of the brain that produces CSF) remains in overdrive or if the waste items aren’t appropriately soaked up by the bloodstream.
Genetic hydrocephalus indicates a baby is born with the condition. This is frequently due to issues like spina bifida (abnormal development of the spinal cord) or aqueductal stenosis (the constricting of a little passage, the “aqueduct of Sylvius,” that links two major ventricles in the brain).
Gotten hydrocephalus takes place after birth and can affect individuals of any age. It’s generally brought on by bleeding in the brain. This can take place in premature babies or individuals who’ve had terrible head injuries. Some kids can develop hydrocephalus due to a growth or infection in the brain. Some cases have no known cause.
Symptoms of Hydrocephalus in Infants
Signs in Babies
Babies under the age of 1 year will have heads that appear very swollen. Their skull bones– thin, bony plates that have actually not yet fused together– are linked by fibrous tissue called stitches. These sutures, or “soft spots,” have actually not yet solidified and therefore stretch and broaden to keep the excess CSF. As an outcome, a baby with hydrocephalus will appear to have an unusually shaped head– usually much larger than other babies the exact same age.
Other signs to try to find include:
- bulging at the soft spots
- ” split” sutures– a space can be felt between skull bones
- rapid boost in head circumference
- swollen veins that are quickly seen with the naked eye
- downward cast of the eyes (called “sunsetting”).
Depending upon how severe the condition is, babies also may appear exceedingly sleepy, picky, and vomit or have seizures. Young kids with hydrocephalus also may miss developmental turning points or might go back to earlier developmental stages. In severe cases, a child also might experience “failure to prosper” and miss development milestones.
Signs in Older Kids
Older children will not have the quickly identifiable symptom of an enlarged head due to the fact that their skull bones have actually fused together and can’t broaden to make room for the excess fluid. In these cases, included pressure on the brain can cause severe headaches that might wake a child in the middle of the night or early in the early morning.
Kids likewise may have:
- problems with balance and motor skills.
- double vision.
- squinting and/or other repetitive eye motions.
Modifications in personality, loss of brand-new developmental abilities (like speaking or walking), and memory loss can happen in advanced cases.
A child who reveals any of the signs and symptoms pointed out above need to see a doctor right away. The doctor will perform examinations, which may include a medical history and diagnostic tests– like ultrasound, CT (computed tomography) scan, or MRI (magnetic resonance imaging)– to get a clear image of the inside of the brain.
Treatment for Hydrocephalus in Infants
It is very important to treat hydrocephalus right now. Unattended hydrocephalus can get worse and cause more problems in the nervous system.
Treatment for hydrocephalus varies depending on the age of the child, the cause of the CSF buildup (whether from a clog, overproduction of fluid, or another problem), and the child’s general health.
Ventriculostomy and Coagulation
Endoscopic 3rd ventriculostomy (ETV) with choroid plexus coagulation (CPC) is a relatively brand-new procedure that is becoming common for kids who require surgery. This minimally invasive approach includes positioning a small, lighted electronic camera (called an endoscope) inside the brain so that cosmetic surgeons can see the surgical site on a computer system monitor. Then, utilizing really small instruments, surgeons make a small hole in the bottom of the third ventricle of the brain.
This creates an “evacuation route” that lets fluid drain from the brain and bypass any obstructions that are triggering a backup. The body then takes in the CSF back into the blood stream as it usually would.
After the ventriculostomy, cosmetic surgeons cauterize (burn somewhat) parts of the choroid plexus, the area of the brain that produces CSF. This is done to lower the amount of CSF that the brain makes.
This surgical method has a greater success rate than shunting (implanting a tube in the brain to drain pipes the fluid), which used to be the requirement surgery for kids with hydrocephalus. It’s performed in kids ages 1 and up, however may be available to more youthful kids in the future.
Kids who have ventriculostomies and coagulation need to subsequent with their care team typically. If they develop hydrocephalus again, medical professionals typically have to do a shunting procedure since a repeat ventriculostomy is not most likely to work.
Shunt treatments, which have actually been done for decades, involve surgery to place one end of a catheter (versatile tube) into a ventricle of the brain and location the other end in the abdominal cavity, chambers of the heart, or area around the lungs. Fluid drains pipes from the brain into these locations and is absorbed by the blood stream. A valve (flap that opens and closes) in the shunt system manages the circulation to prevent over-draining and under-draining.
While shunting has actually been a reliable treatment for hydrocephalus, the long-term success rate of a shunt isn’t great. There is a high chance of failure and complications after a shunt is implanted, with practically half of all shunts failing to work well within the first year. When this happens, a child has to have surgery once again to change a catheter or valve or replace the entire shunt. Many kids who go through shunting will require future operations over their life times to handle shunt problems.
Infections are another side effect of shunting. A lot of infections establish within the first few months after a shunt procedure and require temporary removal of the device while a child receives IV (given through a vein) antibiotics for up to 2 weeks.
Because of the drawbacks of shunting, these procedures are done less and less nowadays. Medical professionals use shunting as an alternative when ventriculostomies and coagulation cannot or don’t work.
With prompt treatment, numerous kids with hydrocephalus go on to lead typical lives.
Those with more intricate medical problems, like spina bifida or bleeding in the brain from prematurity, may have more health issue due these conditions. In these kids, early treatment by developmental specialists, physiotherapists, and physical therapists can make recovery far more most likely and significantly enhance their outcomes.