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Our brains have a clear, colorless fluid to cushion the brain and spinal cord. However, sometimes that can accumulate around the brain and enlarge the spaces within the brain. This condition is called hydrocephalus, or “water on the brain,” and can cause neurological problems.
Hydrocephalus affects developing babies in the womb, as well as children and adults and often requires prompt treatment to drain the fluid from the brain.
Normal pressure hydrocephalus is a brain disorder that primarily affects the elderly. It occurs when excess cerebrospinal fluid, which is made in the brain, accumulates inside the brain. Typically, it is reabsorbed into the bloodstream. It is called “normal pressure” because despite the extra fluid in the brain, the pressure of the fluid is measured is still within normal levels.
In children, hydrocephalus is more commonly “high pressure.” A child may develop hydrocephalus before birth or during childhood.
The exact cause of normal pressure hydrocephalus isn't well understood. The brain produces cerebrospinal fluid at a constant rate that doesn't fluctuate, much like a water faucet that's been left running. When the brain's ability to reabsorb this fluid properly is disrupted for whatever reason, it accumulates, which then causes hydrocephalus.
In children, the inability to properly reabsorb fluid can be due to a birth defect, abnormal development of the nervous system, or structural problems in the brain.
Hydrocephalus may also be a result of bleeding, infections, head trauma, tumors, or cysts.
The risk of hydrocephalus in children is increased if a pregnant woman contracts an infection during pregnancy. This can result in inflammation of the child's brain tissue. Other risk factors are a family history of hydrocephalus and head injuries suffered during childbirth or in childhood.
A diagnosis of pediatric hydrocephalus can be confirmed by ultrasound for infants who are less than one year old. Older children can be diagnosed through a magnetic resonance imaging (MRI) or computerized tomography (CT) scan. During pregnancy, hydrocephalus is typically detected through a prenatal ultrasound between 15- and 35-weeks’ gestation which is then confirmed through a fetal MRI.
Pediatric hydrocephalus is usually treated with surgery to implant a shunt that allows blocked fluid to drain safely into the child's abdomen. Some forms of pediatric hydrocephalus may be treated by a minimally invasive form of spinal fluid diversion that eliminates the need for shunt placement. In the procedure, a tiny, fiber-optic camera called an endoscope provides a clear picture of the ventricles within the brain, where the cerebrospinal fluid is produced. Surgeons cut an opening in the ventricle, making it possible to bypass an obstruction and restore normal fluid flow.
The outcome for most children with hydrocephalus is good. But some children have complications, such as shunt malfunctions and infections from surgery, developmental delays, learning disabilities, and visual problems. Families need to be aware of the lifelong complexities of hydrocephalus to ensure their children receive comprehensive ongoing care.
Yale New Haven Children's Hospital
Yale New Haven Hospital
Yale New Haven Children's Hospital
Yale New Haven Children's Hospital
Yale New Haven Children's Hospital
Yale New Haven Children's Hospital
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