In this condition cerebrospinal fluid (CSF) collects in the ventricles of the brain resulting in increased pressure in the head. It is aptly named as ‘hydro’ means water and ‘cephalus’ refers to the head, albeit the fact that it is CSF instead of water. Now CSF is a clear fluid which surrounds the brain and spinal cord and performs three important functions
- it works as a “shock absorber” protecting the brain and spinal cord
- it delivers nutrients to the brain while simultaneously removing waste
- by flowing between the cranium and spine, it regulates change in pressure within the brain
Every adult produces CSF on a daily basis – nearly a pint or so actually. Sometimes due to an illness or an injury, CSF circulation can be affected. This causes ventricles to enlarge, thereby increasing pressure within the cranium.
Primary hydrocephalus often needs some form of CSF diversion which can be done endoscopically or by insertion of a shunt.
Hydrocephalus can also be due to tumours or lesions which obstruct the flow of CSF. This can also affect the eyes due to pressure on the optic nerves giving rise to a condition called ‘papilledema’. In most cases removal of the tumour restores normal flow of CSF and does not necessitate any specific treatment for the hydrocephalus itself.
Typical symptoms of ‘Normal pressure hydrocephalus’ are the triad of gait disturbances, dementia and urinary incontinence. These are caused by decreased absorption of CSF. It can be diagnosed by draining CSF via a lumbar puncture following which symptoms will dramatically abate.
NPH requires CSF diversion most often by use of a programmable ventriculoperitoneal shunt or a programmable lumbo-peritoneal shunt.
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