HYDROCEPHALUS

Hi, happy new month to everyone. Today I want to talk about a topic that gives me bad memories of my little cousin that we lost to hydrocephalus years back.

By User:Phoenix119 - Own work, CC BY-SA 3.0, Wikimedia

My little cousin, Amanda was delivered in a nearby home of a traditional birth attendant and everyone was happy about the arrival of a beautiful daughter. However, as she started growing, it was noticed that her head was getting larger than normal. This enlargement of her head continued with associated poor head control, somnolence, poor feeding, etc.

The parents were not very exposed and educated. They didn't have any idea what could cause such. They took the child to some spiritual houses and in the end, it was concluded that the child was an evil child sent to torture the parents. This made them develop apathy and neglect towards the child, in addition to the child's worsening clinical state.

The child's condition continued to deteriorate and she eventually died. Even when she died, they said nobody should mourn her. That she was an evil child.

When I left the village and moved to the city to study Medicine, I got to know about hydrocephalus. I saw children with similar conditions being treated and cared for. I see children with hydrocephalus properly managed on shunts and they live their normal lives. I could only wish that if I knew what I know now, my knowledge would have saved Amanda. First, to even disabuse her parent's minds from the local belief that she was an abnormal and evil child.

So each time I talk about the topic of hydrocephalus, Amanda's story is always in my mind. In this post, I will give an overview of what hydrocephalus is and how to manage it.

By شہاب - Own work, CC BY-SA 4.0, Wikimedia

WHAT IS HYDROCEPHALUS?
Hydrocephalus is a condition where there is excessive accumulation of fluid in the cavities (ventricles) of the brain. The brain and spinal cord have fluid that circulates them. This fluid help to supply nutrients and take away waste product. It also acts as a shock absorber and as well regulates the pressure within the brain. This fluid is called cerebrospinal fluid (CSF).

This fluid is produced by a structure in the brain called the choroid plexus of the lateral, 3rd, and 4th ventricles. After circulation, the fluid is drained through many channels and then into the subarachnoid space and finally into the venous sinuses.

The volume of this fluid is tightly regulated such that the amount secreted equals the amount drained. And by so doing a normal CSF volume and pressure are maintained.

But when this balance is disrupted by either excessive secretion of the fluid or blockage of the drainage channels, the fluid will then start accumulating which causes the enlargement of the cerebral ventricles and results in this condition called Hydrocephalus.

By CDC, Public Domain, Wikimedia

The implication of this fluid accumulation and dilation of the ventricles is that there will be raised pressure in the brain (raised intracranial pressure) and damage to some structures in the brain. This will manifest as clinical signs and symptoms of hydrocephalus which include:

For newborns or infants, there will be progressive head enlargement and poor head control, poor feeding, irritability, somnolence, and lethargy. The fontanelles will be full and tense. There will be a regression of previously achieved developmental milestones. Low heart rate, irregular respiration, etc.

Older children and adults may have mental retardation, headache, vomiting, convulsions, abnormal upward gaze of the eye, visual disturbance, etc.

CAUSES OF HYDROCEPHALUS
Some of the causes of increased production or blockage of the drainage channels which manifest as hydrocephalus are;

Abnormalities during the development of the child in the womb that results in a blocked drainage channel when the child is born such as congenital aqueductal stenosis. Or some lesions or tumors growing in the ventricles thereby blocking drainage. Or calcification of some structures like the arachnoid villi.

Conditions that lead to increased production of the cerebrospinal fluid like Infections such as Meningitis, following a traumatic brain injury, or a tumor causing over secretion of CSF like choroid plexus carcinoma.

For a better understanding, hydrocephalus is always classified into congenital or acquired hydrocephalus, obstructive or communicating hydrocephalus, raised pressure or normal pressure hydrocephalus, etc.

By Unknown author - University of Rochester, GFDL, Wikimedia

TREATMENT
The goal of treatment here is to get rid of the accumulated fluid in the brain and also maintain the normal volume and pressure required for the normal functioning of the brain. The treatment is also aimed at preventing or reversing the already ongoing damage to the brain. This can be achieved through medical and surgical treatment.

Medical treatment using drugs is just a temporary measure. The definitive treatment here is surgery. The drugs used are acetazolamide and frusemide which are used to make the body excrete the excess fluid.

The main treatment is surgery. In this surgery, the surgeons will put a pipe called a shunt which will channel the fluid in the brain to any space in the body, especially the stomach. When the shunt is connected between the brain ventricles to the peritoneum of the stomach, it is called a ventriculoperitoneal shunt and this is the commonest treatment. From the stomach, the fluid can find its way out through faces and urine.

Other spaces in the body where the fluid can be channeled to are the superior vena cava, space around the lungs (pleural cavity), etc. Other surgical options are Endoscopic third ventriculostomy and external ventricular drainage.

By Cancer Research UK - Original email from CRUK, CC BY-SA 4.0, Wikimedia

In conclusion, hydrocephalus is a common disorder in children. Some cultures hold some harmful beliefs against these children which we must all correct. A child with hydrocephalus is not an evil child but a child who has a medical condition like every other medical conditions in children or adult.

Hydrocephalus is very treatable and many children have done well with ventriculoperitoneal (VP) shuts. Early detection and prompt treatment are important before damage is caused in the brain.

There is a tape measurement and normal values for the normal head enlargement as the child grows. Any values above this normal value or the presence of any of those clinical signs and symptoms of hydrocephalus should be reported to the doctor for proper investigation and necessary action.

Thanks so much for reading.

For references and further information on hydrocephalus, please visit:

American Association of Neurological Sciences

National Health Service

Kids Health

John Hopkins Medicine

Hydrocephalus Association