Tuesday, June 21, 2016

Understanding Hydrocephalus.

Page Liked · June 19, 2015
Today's Topic of Awareness: Late Onset Hydrocephalus

When an injury or illness alters the circulation of the CSF, one or more of the ventricles becomes enlarged as the CSF accumulates. The skull is rigid does not allow for this excess fluid to be released. In this case, the pressure in the brain may increase profoundly.

In adults this can occur for many reasons, but most often it is due to hemorrhage, infections, brain damage, stroke, or tumors. In some cases no cause can be identified.

The two most common forms of adult hydrocephalus are:

1) Hydrocephalus ex-vacuo:
Hydrocephalus ex-vacuo occurs when a stroke or injury damages the brain and brain matter actually shrinks. The brain may actually shrink in elderly patients or those with Alzheimer’s Disease, and the CSF volume increases to fill the extra space. In this instance, the ventricles are enlarged, but the pressure may or may not be elevated.

2) Normal pressure hydrocephalus (NPH):
Normal pressure hydrocephalus results from the gradual blockage of the CSF draining pathways in the brain. The ventricles enlarge to handle the increased volume of the CSF, and the compression of the brain from within by the fluid-filled ventricles destroys or damages brain tissue. Normal pressure hydrocephalus owes its name to the fact that the ventricles inside the brain become enlarged with little or no increase in pressure. NPH can occur as the result of head injury, cranial surgery, hemorrhage, meningitis or tumor. Unfortunately, the majority of NPH cases are from an unknown cause, making it difficult to diagnose and understand. Compounding this difficulty is the fact that the symptoms of hydrocephalus are similar to the effects of the aging process. The majority of the NPH population is older than 60, and people sometimes live for months or even years with hydrocephalus before seeing a doctor.

Symptoms of Hydrocephalus:
Headaches and nausea are common symptoms of adult-onset hydrocephalus. Other signs of the condition are difficulty focusing the eyes, unsteady walking, weakness of the legs, sudden falls, and a distinctive inability to walk forward, as if the feet are stuck to the floor. As the condition progresses, those with hydrocephalus show decreased mental activity, reflected in withdrawn behavior, lethargy, apathy, impaired memory, and speech problems. Urinary and bowel incontinence can also occur. Dementia, involving loss of movement, sensory functions, and cognitive abilities, are signs as well.

The prognosis for hydrocephalus depends on the cause, the extent of symptoms and the timeliness of diagnosis and treatment. Some patients show a dramatic improvement with treatment while others do not. In some instances of normal pressure hydrocephalus, dementia can be reversed by shunt placement. Other symptoms such as headaches can disappear almost immediately if the symptoms are related to elevated pressure.

In general, the earlier hydrocephalus is diagnosed, the better the chance for successful treatment. The longer the symptoms have been present, the less likely it is that treatment will be successful. Unfortunately, there is no way to accurately predict in an individual case how successful surgery will be. Some patients will improve dramatically while others will reach a plateau or decline after a few months.


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