What You Should Know About Hydrocephalus*
What causes hydrocephalus?
The causes of hydrocephalus are not all well understood. Hydrocephalus may result from developmental disorders such as those associated with neural tube defects including spina bifida and encephalocele. Other possible causes include complications of premature birth such as intraventricular hemorrhage, diseases such as meningitis, tumors, traumatic head injury, or subarachnoid hemorrhage blocking the exit from the ventricles to the cisterns and eliminating the cisterns themselves.
What are the symptoms of hydrocephalus?
Symptoms vary with age, disease progression and individual differences in tolerance to CSF. For example, an infant's ability to tolerate CSF pressure differs from an adult's. The infant skull can expand to accommodate the buildup of CSF because the sutures (fibrous joints that connect the bones of the skull) have not yet closed. In infancy, the most obvious indication of hydrocephalus is the rapid increase in head circumference or an unusually large head size. Other symptoms may include vomiting, sleepiness, irritability, downward deviation of the eyes (also called "sun setting") and seizures.
Older children and adults may experience different symptoms because their skulls cannot expand to accommodate the buildup of CSF. Symptoms may include:
- Headache
- Vomiting and/or nausea
- Papilledema (swelling of the optic disk which is part of the optic nerve)
- Visual disturbances: blurred vision, diplopia (double vision), and sun setting of the eyes
- Difficulty with balance, poor coordination, and gait disturbance
- Urinary Incontinence
- Slowing or loss of development
- Lethargy, drowsiness, irritability and or other changes in personality or cognition including memory loss
Normal Pressure Hydrocephalus
Symptoms of NPH include progressive mental impairment and dementia, problems with walking, and impaired bladder control leading to urinary frequency and/or incontinence. They may have a general slowing of movements or may complain that their feet feel "stuck." Because these symptoms are similar to other disorders such as Alzheimer's disease, Parkinson's disease, and Creutzfeldt-Jakob disease, NPH is often misdiagnosed. Many cases go unrecognized and are never properly treated. Doctors may use a variety of tests, including brain scans (CT and/or MRI), a spinal tap or lumbar catheter, intracranial pressure monitoring, and neuropsychological tests to help them diagnose NPH and rule out other conditions.
The symptoms described in this section account for the most typical ways in which progressive hydrocephalus manifests. It is, however, important to remember that symptoms vary significantly from individual to individual.
* Information provided by the National Institute of Neurological Disorders and Stroke (NINDS).