Hydrocephalus

Hydrocephalus is a neurological condition caused by an abnormal build-up of CSF within rooms inside the brain called ventricles.  CT scan or MRI typically shows enlarged ventricles.

Idiopathic Intracranial Hypertension (IIH)

IIH is a condition related to high pressure in the brain.  “Idiopathic” means that the cause is unknown.  High pressure is likely caused by imbalance between the production and absorption of CSF.  Mostly, young females are affected.  Typical symptoms include severe headache, blurred vision, visual loss, blindness, double vision and ringing of the ear. 

Other Conditions

Although less common, intracranial hypotension (low pressure within the brain) could occur.  In most cases this is caused by leakage in the CSF in the spine.

Adult hydrocephalus is divided into 4 categories listed below:

Normal Pressure Hydrocephalus (NPH)

Normal Pressure Hydrocephalus (NPH) is a condition where there is excess of cerebral spinal fluid (CSF) in the ventricles of the brain.  This condition often occurs with little or no change in intracranial pressure.  It is believed that CSF is not being fully and effectively absorbed by the body.  NPH affects more than 1 in 200 adults over the age of 55, and the cause is unknown. 

Congenital Hydrocephalus

People with congenital hydrocephalus may become adults without developing symptoms and start showing problems later in life.  CT scan typically shows enlarged ventricles.  Treatment is depending on the symptoms and the type of hydrocephalus. 

Transitional Hydrocephalus from Childhood Hydrocephalus

A number of patients who are treated for hydrocephalus as children are now in the adult age group.  There is a tendency that these people are not well followed by the specialist.  Hydrocephalus and CSF Disorders Clinic is actively seeing these patients in order to prevent future complications related to hydrocephalus or shunt.

Symptomatic Hydrocephalus

Brain trauma, brain bleed, infection and tumor could cause hydrocephalus.  These patient’s hydrocephalus is often treated with their original conditions. 

NPH is most commonly characterized by the gradual onset of three symptoms: walking and balance difficulties, urinary urgency, frequency and/or incontinence, and memory problem or cognition issues.  NPH can be difficult to diagnose since not all the symptoms may come on at the same time and usually appear gradually.  Unfortunately, this condition is under diagnosed, often progresses to severe symptoms without being recognized.  If recognized and managed properly, it is possible to stop the damage caused by NPH and for most patients, to regain some function. 

If NPH is suspected, our clinic will complete a detailed history and physical, do a walking and mobility assessment, and review a CT scan to determine if there is excessive CSF present.  If NPH is suspected on the scan, further investigation is indicated.  A lumbar puncture will be performed to remove a large volume of CSF.  If symptoms of NPH are relieved by CSF removal, this is a strong indication that the patient will benefit from a shunt surgery.  The surgical placement of the shunt will help redirect the excessive CSF from the brain and relieve the symptoms of NPH. 

IIH is often treated by a neurologist at the beginning.  The treatment can include medication and weight loss.  Ophthalmological evaluation is essential, and, in most cases, there is a sign of high brain pressure in the back part of the eye called papilledema.  When the medical treatment fails or the patient continues to lose eyesight, surgical treatment will be considered.  The mainstream of treatment is shunt surgery. 

Shunt Surgery

Ventriculoperitoneal (VP) Shunt: One small incision is made in the scalp. A small hole is then made into the skull and a tiny opening is made in the dura, a protective covering of the brain. These openings are made to accommodate the ventricular (proximal) catheter being placed into the lateral ventricle. The shunt valve is usually placed above or behind one ear and attaches it to the two catheters. The distal catheter is then tunneled under the skin to the abdomen where an additional small incision is made. Finally, the end of the catheter is carefully placed in the peritoneal cavity.

Lumboperitoneal (LP) Shunt: An incision is made near the base of the spine, and a small catheter is inserted into the subarachnoid space of the lower spine.  This is the same location where a lumbar puncture takes place. The catheter is attached to the valve, which is usually placed around the hip bone, and then the distal catheter is tunneled under the skin to the abdomen, where it is inserted in the peritoneal cavity.

Endoscopic Third Ventriculostomy (ETV)

In certain types of hydrocephalus, instead of placing the shunt, it is possible to create a channel within the ventricle system.  This procedure is done by using a neuro-endoscope.  CSF will flow through the new opening inside of the brain to relieve the hydrocephalus. 

A referral to Hydrocephalus and CSF Disorders Clinic can be sent from a neurologist, ophthalmologist, geriatric medicine specialist, and family physicians.  The patient must have a    recent CT scan before referral.

Hydrocephalus and CSF Disorders Clinic Nurse Coordinator, Sara McLeod – (306) 655-0965.

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