Hydrocephalus, (pronounced / ha dr s f l s/), also known as "water on the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid
(CSF) in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head, convulsion, and mental disability. Hydrocephalus can also cause death. The name derives from the Greek words - (hudro-) "water", and (kephalos) "head". Symptoms of increased intracranial pressure may include headaches, vomiting, nausea, papilledema, sleepiness, or coma. Elevated intracranial pressure may result in uncal and/or cerebellar tonsill herniation, with resulting life threatening brain stem compression. For details on other manifestations of increased intracranial pressure: In infants with hydrocephalus, CSF fluid builds up in the central nervous system, causing the fontanelle (soft spot) to bulge and the head to be larger than expected. Early symptoms may also include: Eyes that appear to gaze downward, Irritability, Seizures, Separated sutures, Sleepiness, Vomiting. Symptoms that may occur in older children can include: Brief, shrill, high-pitched cry, Changes in personality, memory, or the ability to reason or think, Changes in facial appearance and eye spacing, Crossed eyes or uncontrolled eye movements, Difficulty feeding, Excessive sleepiness, Headache, Irritability, poor temper control, Loss of bladder control (urinary incontinence), Loss of coordination and trouble walking, Muscle spasticity (spasm), Slow growth (child 0±5 years), Slow or restricted movement,Vomiting. The skull of a newborn baby is often full of liquid, either because the matron has compressed it excessively or for other, unknown reasons. The volume of the skull then increases daily, so that the bones of the skull fail to close. In this case, we must open the middle of the skull in three places, make the liquid flow out, then close the wound and tighten the skull with a bandage. Hydrocephalus is one of the most common developmental disabilities. It is the leading cause of brain surgery for children in the United States. Pediatric hydrocephalus may also be a heritable condition, and mainly affects males. Hydrocephalus may be detectable during prenatal ultrasound examinations. One of the most performed treatments for hydrocephalus, the cerebral shunt, was first developed in 1960. The shunt must be implanted through neurosurgery into the patient's brain, a procedure which itself may cause brain damage. An estimated 50% of all shunts fail within two years, requiring further surgery to replace the shunts. In the past 25 years, death rates associated with hydrocephalus have decreased from 54% to 5% and the occurrence of intellectual disability has decreased from 62% to 30%. Hydrocephalus also causes infection in the cerebrospinal fluid. It can also result from maternal infection during birth. Pathology Hydrocephalus is usually due to blockage of cerebrospinal fluid (CSF) outflow in the ventricles or in the subarachnoid space over the brain. In a person without hydrocephalus, CSF continuously circulates through the brain, its ventricles and the spinal cord and is continuously drained away into the circulatory system. Alternatively, the condition may result from an overproduction of the CSF fluid, from a congenital malformation blocking normal drainage of the fluid, or from complications of head injuries or infections. Compression of the brain by the accumulating fluid eventually may cause convulsions and mental retardation. These signs occur sooner in adults, whose skulls no longer are able to expand to accommodate the increasing fluid volume within. Fetuses, infants, and young children with hydrocephalus typically have an abnormally large head, excluding the face, because the pressure of the fluid causes the individual skull bones ² which have yet to fuse ² to bulge outward at their juncture points. Another medical sign, in infants, is a characteristic fixed downward gaze with whites of the eyes showing above the iris, as though the infant were trying to examine its own lower eyelids.
Spontaneous intracerebral and intraventricular hemorrhage with hydrocephalus shown on CT scan The elevated intracranial pressure may cause compression of the brain, leading to brain damage and other complications. Conditions among affected individuals vary widely. Children who have had hydrocephalus may have very small ventricles, and presented as the "normal case". If the foramina (pl.) of the fourth ventricle or the cerebral aqueduct are blocked, cerebrospinal fluid (CSF) can accumulate within the ventricles. This condition is called internal hydrocephalus and it results in increased CSF pressure. The production of CSF continues, even when the passages that normally allow it to exit the brain are
However the severity of hydrocephalus can differ considerably between individuals and some are of average or above-average intelligence. the upper eyelids become retracted and the eyes are turned downwards (due to hydrocephalic pressure on the mesencephalic tegmentum and paralysis of upward gaze). papilloma of choroid plexus). and frequent vomiting. and the infant shows lack of interest in his surroundings.
Based on its underlying mechanisms. intracranial hemorrhage (subarachnoid or intraparenchymal) and is usually extremely painful. Later on. infections or congenital malformations). Internal hydrocephalus can be successfully treated by placing a drainage tube (shunt) between the brain ventricles and abdominal cavity to eliminate the high internal pressures. A shunt system can also be placed in the lumbar space of the spine and have the CSF redirected to the peritoneal cavity (Lumbar-peritoneal shunt). but alternative sites include the right atrium (ventriculo-atrial shunt). Someone with hydrocephalus may have motion and visual problems. It involves the placement of a ventricular catheter (a tube made of silastic). as in aqueduct stenosis. They may reach puberty earlier than the average child (see precocious puberty). The cerebral aqueduct may be blocked at the time of birth or may become blocked later in life because of a tumor growing in the brainstem. Hydrocephalus can also be caused by overproduction of cerebrospinal fluid (relative obstruction) (e. The head becomes so enlarged that the child may eventually be bedridden. and gallbladder. hemorrhages. There is some risk of infection being introduced into the brain through these shunts.g. who tend to score better on verbal IQ than on performance IQ.
Congenital in newborns and toddlers with hydrocephalus. Thus resulting in further damage of the brain tissue and leading to
necrotization. About 80-90% of fetuses or newborn infants with spina bifida²often associated with meningocele or myelomeningocele²develop hydrocephalus. As the hydrocephalus progresses. the pressure may also severely enlarge the head. fluid builds inside the brain causing pressure that compresses the nervous tissue and dilates the ventricles. Movements become weak and the arms may become tremulous. Both forms can be either congenital or acquired.g. Effects Because hydrocephalus can injure the brain. This may or may not be appropriate based on individual anatomy.
. About one in four develops epilepsy. into the cerebral ventricles to bypass the flow obstruction/malfunctioning arachnoidal granulations and drain the excess fluid into other body cavities. the head circumference is enlarged rapidly and soon surpasses the 97th percentile. torpor sets in. Papilledema is absent but there may be reduction of vision. Consequently. brain tumors. A subarachnoid hemorrhage may block the return of CSF to the circulation. and the shunts must be replaced as the person grows. thought and behavior may be adversely affected.Hydrocephalus can be caused by impaired cerebrospinal fluid (CSF) flow. pleural cavity (ventriculo-pleural shunt). however. which is thought to reflect the distribution of nerve damage to the brain. compressing neural tissues and causing brain damage. from where it can be resorbed.. poor feeding. Acquired This condition is acquired as a consequence of CNS infections.
The most common cause of hydrocephalus is CSF flow obstruction. head trauma. firm anterior and posterior fontanel s may be present even when the patient is in an upright position. Treatment Hydrocephalus treatment is surgical. or may be clumsy. An alternative treatment for obstructive hydrocephalus in selected patients is the endoscopic third ventriculostomy (ETV). Compression of the nervous tissue usually results in irreversible brain damage. problems with coordination.blocked. If CSF accumulates in the subarachnoid space. whereby a surgically created opening in the floor of the third ventricle allows the CSF to flow directly to the basal cisterns. reabsorption. Since the skull bones have not yet firmly joined together. hindering the free passage of cerebrospinal fluid through the ventricular system and subarachnoid space (e. In this condition. Most shunts drain the fluid into the peritoneal cavity (ventriculo-peritoneal shunt).
The infant exhibits fretfulness. If the skull bones are not completely ossified when the hydrocephalus occurs. stenosis of the cerebral aqueduct or obstruction of the interventricular foramina . pressure is applied to the brain externally. meningitis. the condition is called external hydrocephalus. bulging. Learning disabilities including short-term memory loss are common among those with hydrocephalus.. or excessive CSF production.foramina of Monro secondary to tumors. hydrocephalus can be classified into communicating and non-communicating (obstructive). thereby shortcutting any obstruction.
known as the brain stem. meningitis or head injury. If the patient lies down. vomiting. with the head at roughly the same level as the feet.The classical clinical signs in infancy result from an increase in the pressure within the skull.to appear when the patient is vertical. Could you please tell me the symptoms of hydrocephalus and the therapies available for the treating of the disorder? Answer In order to discuss hydrocephalus. irritability. becomes blocked (clogged). severe headaches. Resistance to traditional analgesic pharmacological therapy may also be a sign of shunt over drainage or failure. along with infection of the shunt tract following surgery (the most common reason for shunt failure is infection of the shunt tract). or failure of reabsorption due to obstruction of the passageways out of the fourth ventricle. otherwise brain tissue will be compressed. The face becomes relatively smaller by comparison and the child's eyes can appear like 'the setting sun' owing to distortion of the surrounding bones. The condition may occur in adults following stroke (cerebrovascular accident). At any age. The skull may be considered to be a watertight box containing the brain. In these cases the condition may be transient. depending on where the excess pressure is exerting its effect on the brain. seizures. Diagnosis of the particular complication usually depends on when the symptoms appear . Since the cost of shunt systems is beyond the reach of common people in developing countries. nausea. weakness in the arms or legs. Another complication can occur when CSF drains more rapidly than it is produced by the choroid plexus. The brain and spinal cord are covered by three membranes. Excessive production of CSF. Cells in the lateral ventricles and third and fourth ventricles secrete CSF. Difficulty in diagnosing over drainage can make treatment of this complication particularly frustrating for patients and their families. it may stop working if it disconnects. some extremely serious. The latter occurs when there is a mechanical blockage. Hydrocephalus can also occur early in life following a bleed within the brain tissue or a meningitis infection. most people with hydrocephalus die without even getting a shunt. The two (one on either side) in the so-called cerebral hemispheres are termed the lateral ventricles. and it is these that become inflamed in meningitis. Any increase in circulating blood within the brain must therefore be associated with a decrease in CSF volume. and normally allows a uniform pressure to be maintained on the nervous tissue structure. There are four ventricles.Shunt complications Examples of possible complications include shunt malfunction. with an abnormal shape. only 30% are a patient's first surgery)  and it is not uncommon for patients to have multiple shunt revisions within their lifetime. The child's head increases in circumference and becomes larger than normal for its age. vertigo. whilst the two in the mid brain. There is a space between the first membrane covering the nervous tissue and the second called the subarachnoid space. clinical examination of the nervous system can also produce a variety of abnormal signs. CSF acts as a Support structure for the brain and spinal cord. Although a shunt generally works well. migraines. infected. Treatment will vary with the cause and therefore the prognosis of the condition. when the condition becomes apparent during infancy. like seizures. A CT scan may or may not show any change in ventricle size. a change in personality. are termed the third and fourth ventricles. dizziness.
The diagnosis of cerebrospinal fluid buildup is complex and requires specialist expertise. one needs first to say something of the anatomy and physiology of the brain. prominent veins on the forehead and a wide soft spot (fontanelle) on top. or externally by a tube into the abdominal (peritoneal) cavity or via the major veins in the neck and eventually therefore on into the
. or it is outgrown. extending down through the brain stem into the central channel running through the middle of the spinal cord. If this happens the cerebrospinal fluid will begin to accumulate again and a number of physical symptoms will develop (headaches. the symptoms usually vanish in a short amount of time. auditory hyperesthesia (sound sensitivity). collectively known as the meninges. All four ventricles are in physical communication with one another and also communicate with the subarachnoid space via passageways out of the fourth ventricle. whether symptoms occur when the patient is upright or in a prone position. sometimes relating to a defect of development.that is. the fluid is either diverted internally within the CSF circulation system. The normal volume of circulating CSF within the system of ventricles described above is around 125ml. and shunt infection. vomiting. The shunt failure rate is also relatively high (of the 40. light sensitivity. shunt failure. causing symptoms -listlessness. particularly if the patient has a history of slit-like ventricles. leads to an accumulation of fluid in the brain ventricles leading to hydrocephalus.000 surgeries performed annually to treat hydrocephalus. there are procedures that can be performed to bypass the obstruction and thus relieve the increased CSF pressure. It is filled with a fluid known as cerebrospinal fluid or CSF. The same fluid is found in hollow cavities (ventricles) within each side of the brain and the part of the brain that joins the base to the spinal cord. As a result. When surgery is indicated. photophobia/light sensitivity). and double vision . blood and CSF. CSF produced by the cells in the ventricles is reabsorbed by frond-like cells (villa) associated with the spinal cord. Tumors may also give rise to CSF outflow obstruction and consequent hydrocephalus. strabismus. nausea.
Based on its underlying mechanisms. producing dilation of the ventricles. Dynamic compliance studies may be also helpful. It is also associated with spina bifida. reabsorption. infections or congenital malformations). stenosis of the cerebral aqueduct or obstruction of the interventricular foramina ± foramina of Monro secondary to tumors. y Various neurologic conditions may result in communicating hydrocephalus.g. and non-communicating (obstructive).Usually. since more often than not. characterized by enlarged cerebral ventricles. Hydrocephalus is a condition caused by an imbalance in the production and absorption of CSF in the ventricular system. and mental disability.. CSF accumulates. The diagnosis of NPH can be established only with the help of continuous intraventricular pressure recordings (over 24 hours or even longer). Both forms can be either congenital. Etiology: Congenital hydrocephalus usually results from defects. Classification of Hydrocephalus: Hydrocephalus can be caused by impaired cerebrospinal fluid (CSF) flow. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head. also known as non-obstructive hydrocephalus y It is caused by impaired cerebrospinal fluid resorption in the absence of any CSF-flow obstruction. convulsion.
. this is a compensatory enlargement of the CSF-spaces in response to brain parenchyma loss ± it is not the result of increased CSF pressure. with only intermittently elevated cerebrospinal fluid pressure. as well as increased viscosity of the cerebrospinal fluid. and is usually due to brain atrophy (as it occurs in dementias). Chiari malformation.Hydrocephalus occurs with a number of anomalies. hindering the free passage of cerebrospinal fluid through the ventricular system and subarachnoid space (e.. or cavities.g. usually under pressure. instant measurements yield normal pressure values. Hydrocephalus ex vacuo also refers to an enlargement of cerebral ventricles and subarachnoid spaces. hydrocephalus does not cause any intellectual disability if recognized and properly treated.
Normal pressure hydrocephalus (NPH) is a particular form of communicating hydrocephalus. It is a term derived from the Greek words ³hydro´ meaning water. As opposed to hydrocephalus.People with hydrocephalus have abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles. intracranial infections or dormant development defects. post-traumatic brain injuries and even in some psychiatric disorders. including subarachnoid/intraventricular hemorrhage. hydrocephalus can be classified into communicating. When production exceeds absorption. Communicating
y Communicating hydrocephalus. or excessive CSF production. and this condition is sometimes known as ³water on the brain´.
The most common cause of hydrocephalus is CSF flow obstruction. A massive degree of hydrocephalus rarely exists in typically functioning people. papilloma of choroid plexus). y It has been theorized that this is due to functional impairment of the arachnoid granulations. though such a rarity may occur if onset is gradual rather than sudden. Hydrocephalus can also be caused by overproduction of cerebrospinal fluid (relative obstruction) (e. and ³cephalus´ meaning head. which are located along the superior sagittal sinus and is the site of cerebrospinal fluid resorption back into the venous system. such as schizophrenia. hemorrhage. Altered compliance (elasticity) of the ventricular walls. of the brain. and congenital absence of arachnoidal granulations (Pacchioni¶s granulations). may play a role in the pathogenesis of normal pressure hydrocephalus.right side of the heart. meningitis. such as NTD¶s.Acquired hydrocephalus usually results from space-occupying lesions. or acquired. such as Chairi malformations.
meningitis. Dandy-Walker malformation).
y y y y y
Foramen of Monro obstruction may lead to dilation of one or.g. 3. and 5) Dandy-Walker malformation. Movements become weak and the arms may become tremulous. including the fourth ventricle. As the hydrocephalus progresses. Later on. 2. For head enlargement to occur.g. 4) aqueduct atresia and stenosis. or obstructive hydrocephalus.. The foramina of Luschka and foramen of Magendie may be obstructed due to congenital failure of opening (e. leading to widespread dilatation. poor feeding. is caused by a CSF-flow obstruction (either due to external compression or intraventricular mass lesions). which include 1) intraventricular matrix hemorrhages in premature infants. The aqueduct of Sylvius. the head circumference is enlarged rapidly and soon surpasses the 97th percentile. if large enough (e. In newborns and toddlers with hydrocephalus. normally narrow to begin with. torpor sets in.
Pathophysiology of Hydrocephalus: Clinical Manifestations: 1.Non-communicating Non-communicating hydrocephalus. may be obstructed by a number of genetically or acquired lesions (e.
. intracranial hemorrhage (subarachnoid or intraparenchymal) and is usually extremely painful.
The cranial bones fuse by the end of the third year of life. hemorrhage.. both lateral ventricles. 2) infections. About 80-90% of fetuses or newborn infants with spina bifida²often associated with meningocele or myelomeningocele²develop hydrocephalus. bulging. and frequent vomiting. tumor) and lead to dilatation of both lateral ventricles as well as the third ventricle. head trauma. The causes are usually genetic but can also be acquired and usually occur within the first few months of life. brain tumors. Fourth ventricle obstruction will lead to dilatation of the aqueduct as well as the lateral and third ventricles. The head becomes so enlarged that the child may eventually be bedridden. in colloid cyst).. ependymitis. and the infant shows lack of interest in his surroundings. The subarachnoid space surrounding the brainstem may also be obstructed due to inflammatory or hemorrhagic fibrosing meningitis.
This condition is acquired as a consequence of CNS infections. hydrocephalus must occur before then. Papilledema is absent but there may be reduction of vision. the upper eyelids become retracted and the eyes are turned downwards (due to hydrocephalic pressure on the mesencephalic tegmentum and paralysis of upward gaze). Since the skull bones have not yet firmly joined together. firm anterior and posterior fontanelles may be present even when the patient is in an upright position.g. Abnormal rate of head growth Bulging fontanel Tense anterior fontanel (often bulging and nonpulsatile) Dilated scalp veins
4. 3) type II Arnold-Chiari malformation. atresia. The infant exhibits fretfulness.
3. perforation of organs. anterior fontanels for size and fullness and behavior. check also for irritability. 9. strabismus. and LOC. abdominal abscess. Give small. Administer prescribed medications which may include antibiotics to prevent infection and analgesics for pain.5. 2. papilledema. (Tran uterine placement of ventriculoamniotic shunts during late pregnancy is still being developed as a treatment modality). e. Provide skin care for the head to prevent breakdown. cranial sutures. ataxia. Laboratory and Diagnostic Study Findings: 1. fistulas. CT scan will diagnose most cases postnatal. Teach the family about the management required for the disorder a. 10. A third ventriculostomy is a new no shunting procedure used to treat children with hydrocephalus. 11. lethargy. Other complications include subdural hematoma caused by a too rapid reduction of CSF. Firmly support the head and neck when holding the child. b. Level II ultrasonography of the fetus will allow a prenatal diagnosis. The major complications of shunts are infections and malfunction 2. MRI can be used if a complex lesion is suspected. b. apathy and confusion. 3. irritability. Provide Postoperative nursing care (nursing interventions are the same as those for increased ICP) a. altered feeding habits and a high-pitched cry. 6. Encourage parental-newborn bonding. c. 8. Provide shunt care
. fontanels. 2. usually peritoneum (ventriculoperitoneal shunt) 1. d. Assess for signs of increased ICP and check the following. hernias and ileums. Treatment is surgical by direct removal of an obstruction and insertion of shunt to provide primary drainage of the CSF to an extra cranial compartment. b. frequent feedings to decrease the risk of vomiting. Provide preoperative nursing care a. Assess head circumference. which include headache on awakening with improvement following emesis. 7. c.
McEwen¶s sign (³cracked pot´) Frontal bossing Setting sun sign Sluggish and unequal pupils Irritability and lethargy with varying LOC Abnormal infantile reflexes Possible cranial nerve damage
Manifestations in children include possible signs of increased ICP.
Nursing Management: 1. head circumference (daily). peritonitis.
In children the symptoms tend to be related to high pressure and may include nausea. irritability. Encourage the child to participate in age-appropriate activities as tolerated. Monitor for shunt infection and malfunction which may be characterized by rapid onset of vomiting.1. Teach home care a. More tests are often performed in adults. Over drainage may lead to slit ventricle syndrome whereby the ventricle become accustomed to a very small or slit like configuration.
. In older adults with NPH the symptoms are more likely to be loss of function in three main areas: walking. congenital hydrocephalus is now often diagnosed before birth through routine ultrasound. routine ultrasound can detect enlarged ventricles (spaces) within the baby¶s brain. symptoms and diagnostic tests for hydrocephalus in various age groups. and fluid around the shunt valve. dizziness and nausea). Encourage the parents to provide as normal lifestyle as possible. Subtle signs include changes in school performance. Hydrocephalus diagnosed in adulthood may have existed since birth and can still be considered congenital and may be referred to as compensated hydrocephalus. 2.
y y y y
Prenatal Infants. 4. b. Irritability Headache. and mild behavior changes. redness along the shunt tract. Congenital hydrocephalus results from a complex interaction of genetic and environmental factors and is present at birth. severe headache. Sleepiness. Arrange for the child to have frequent developmental screenings and routine medical checkups. Vision Downward Deviation of Eyes Young & Middle Aged Adults Difficulty Walking Cognitive Challenges Urinary Urgency or Incontinence Chronic Headaches Older Adults (NPH) Difficulty Walking Cognitive Challenges Urinary Urgency or Incontinence
The most common initial diagnostic test to determine hydrocephalus at any age is an image of the brain (CT scan or MRI) to identify the enlarged ventricles (spaces) within the brain that are typical of hydrocephalus. Vomiting. vomiting. Symptoms and Diagnostic Tests Symptoms of untreated hydrocephalus are variable. intermittent headache. lethargy. The following links take you to detailed information about the signs. Explain how to recognize signs and symptoms of increased ICP. Children and Teenagers Adults Diagnosed in Young and Middle Age Older Adults with Normal Pressure Hydrocephalus (NPH)
Classifications & Causes Doctors often identify hydrocephalus in one of three ways. Bulging Fontanel Prominent Scalp Veins Skull bones may feel separated Vomiting. During pregnancy. Prevent infection (usually from Staphylococcus epidermis or Staphylococcus aureus) 3. Remind both the child and parents that contact sports are prohibited. In young and middle aged adults symptoms run the gamut of those seen in children and in older adults and most often include dizziness and vision problems. Nausea. limiting the buffering ability to increased ICP variations. Infants and Children Abnormal Head Enlargement Tense. Though it might not be recognized and diagnosed immediately. headache and vision problems. Monitor for shunt over drainage (headache. c. thinking and bladder control. fever.
Please see the Dandy-Walker Alliance website for further information. In children.org. Both types occur in the bottom of the brain stem where the brain and spinal cord join. which most frequently affects premature newborns. Fluid accumulates ³upstream´ from the obstruction. brain tumor. intraventricular hemorrhage or infection of the central nervous system. please visit NeurosurgeryToday. blocking CSF¶s flow out of the fourth ventricle and producing hydrocephalus. where the spinal cord is exposed at birth and is often leaking CSF. it is called noncommunicating hydrocephalus. two shunts are placed in the child¶s ventricles ² one in the lateral ventricle and another in the fourth ventricle to manage the hydrocephalus. producing hydrocephalus. perhaps because of infection. Chiari II is explained under Neural Tube Defects. is called a myelomeningocele. An open NTD. The lowest portion of the brain is displaced and is lower than normal pushing down into the spinal column. hemorrhage. another cause of congenital hydrocephalus. These cysts are filled with CSF and lined with the arachnoid membrane (one of the three meningeal coverings). Dandy-Walker Syndrome In Dandy-Walker syndrome. which causes part of the cerebellum and the fourth ventricle to push downward through the opening at the base of the skull into the spinal cord area. This kind of NTD usually leads to the Chiari II malformation. Another set of terms you may hear from a doctor to describe hydrocephalus are ³communicating´ and ³non-communicating´. narrow passageway between the third and fourth ventricles (the aqueduct of Sylvius) is narrowed or blocked. they¶re often located at the back of the brain (posterior fossa) and in the area of the third ventricle. cyst. it is referred to as idiopathic which is most commonly true of normal pressure hydrocephalus (NPH). When the long. The fluid trapped by the cysts may block the CSF pathways. Intraventricular Hemorrhage An intraventricular hemorrhage. Causes The most common causes of congenital and acquired hydrocephalus are listed below. If there is a physical blockage such as a tumor somewhere in that system. producing hydrocephalus. Some arachnoid cysts are self-contained.Acquired hydrocephalus develops after birth as a result of neurological conditions such as head trauma. If the cerebrospinal fluid (CSF) flows freely throughout the brain¶s ventricular system and the subarachnoid space. while others are connected with the ventricles or the subarachnoid space. or a tumor. the fourth ventricle becomes enlarged because its outlets are partly or completely closed. Chiari Malformation There are two types of Chiari malformation. This condition is often referred to as spina bifida. To learn more about Chiari I. Arachnoid Cysts Congenital hydrocephalus can also be caused by arachnoid cysts. Please see the websites of the Spina Bifida Association and the International Association for Spina Bifida and Hydrocephalus for more information on neural tube defects. and part of the cerebellum fails to develop. may cause an acquired form of
. which may occur anywhere in the brain. Congenital Acquired
y y y y y
Aqueductal stenosis Neural tube defect Arachnoid cysts Dandy-Walker syndrome Chiari malformation
y y y y
Intraventricular hemorrhage Meningitis Head injury Brain tumor
Aqueductal Stenosis The most common cause of congenital hydrocephalus is an obstruction called aqueductal stenosis. Neural Tube Defect Another common cause is a neural tube defect (NTD). Dandy-Walker syndrome may also be associated with abnormal development in other parts of the brain and sometimes leads to aqueductal stenosis. it is referred to as communicating hydrocephalus. If the cause of hydrocephalus is unknown. In some instances.
For more information. brain tumors most commonly occur in the back of the brain (posterior fossa). A tumor somewhere else in the brain might also block or compress the ventricular system. hydrocephalus results. and hydrocephalus develops. As a tumor grows. Caused by a bacterial or (less frequently) viral infection. Sites of CSF absorption might then be blocked by scarred membranes (meninges) or by blood cells. The CSF flow is restricted. causing inflammation. please see the National Brain Tumor Foundation website. or blood vessels. When small blood vessels alongside the ventricular lining rupture. blocking the flow of CSF and causing hydrocephalus. it may fill or compress the fourth ventricle. which allow CSF to be absorbed. Blood from ruptured vessels may enter the CSF pathway. blood may block or scar the ventricles or plug the arachnoid villi. An acquired form of hydrocephalus may develop if this scarring obstructs the flow of CSF as it passes through the narrow ventricles or over the surfaces of the brain in the subarachnoid space. nerves. Brain Tumors In children. Meningitis Meningitis is an inflammation of the membranes of the brain and spinal cord.hydrocephalus. meningitis can scar the delicate membranes (meninges) that line the CSF pathway. When the CSF can¶t be absorbed.
. Head Injury A head injury can damage the brain¶s tissues.