Causes of Hydrocephalus

Written by Jiang Fang Shuai
Neurosurgery
Updated on September 18, 2024
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Under normal conditions, the secretion, circulation, and absorption of cerebrospinal fluid (CSF) maintain a dynamic balance. In some pathological states, this balance is disrupted, leading to an excessive accumulation of CSF within the ventricular system, a condition known as hydrocephalus. Hydrocephalus can be classified into obstructive hydrocephalus and communicating hydrocephalus. The causes of obstructive hydrocephalus mainly include obstructions in the ventricular system, such as congenital malformations or abnormal development of the cerebral aqueduct, which are the most common causes of hydrocephalus in infants. In adults, tumors, bleeding, blockages, or compression of the ventricular system are also common causes of hydrocephalus. Communicating hydrocephalus results primarily from acquired diseases, such as cranial infections or blockages of arachnoid granulations by subarachnoid hemorrhage, leading to impairments in CSF absorption.

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Does hydrocephalus affect intelligence?

Mild hydrocephalus generally does not significantly affect intellectual levels, while moderate or severe hydrocephalus often impacts a patient’s intelligence. In children, it can cause severe impairment in intellectual development. For adults, it results in noticeable intellectual deficiencies, primarily characterized by significant cognitive dysfunction, reduced memory, diminished calculating abilities, and weakened verbal communication skills. Additionally, individuals may appear indifferent, speak less, are reluctant to interact with others, and have difficulty expressing themselves. Furthermore, most patients experience reduced orientation abilities concerning time, people, and space, which are predominantly caused by hydrocephalus.

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Will hydrocephalus cause the fontanel to bulge?

Hydrocephalus comes in two types: obstructive hydrocephalus and communicating hydrocephalus. Obstructive hydrocephalus is characterized by the inability of cerebrospinal fluid (CSF) to flow from the brain to the spinal cord, preventing normal circulation. In this situation, the pressure inside the skull can gradually increase due to the buildup of fluid, potentially leading to the progressive bulging of a child's fontanel. On the other hand, communicating hydrocephalus involves the CSF being able to circulate between the brain cavities and the spinal cord, merely resulting in an enlargement of the ventricles without the bulging of the fontanel.

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Symptoms of hydrocephalus in children

For pediatric hydrocephalus, a range of specific symptoms and signs will appear. For instance, children may repeatedly complain of headaches, dizziness, nausea, vomiting, accompanied by a strong sense of vertigo. Through physical examination, it can be found that the head circumference of the child is significantly larger than that of normal children, with the anterior fontanelle full and bulging. Special physical examinations may reveal the presence of a sunset sign or a cracked pot sound. In addition, some children may exhibit certain levels of cognitive dysfunction, lower intellectual development, significantly lagging behind peers, and they might also show instability in walking, swaying back and forth, prone to falling, or even experience urinary and fecal incontinence.

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Causes of hydrocephalus

There are many causes of hydrocephalus, and it is important to make specific judgments based on the circumstances. In some infants, congenital hydrocephalus can be caused by intracranial birth injuries, which occur during the birth process and lead to intracranial hemorrhaging. It can also be due to congenital developmental abnormalities, such as anencephaly or spina bifida. In adults, hydrocephalus can be caused by intracranial tumors, such as choroid plexus papillomas, which overproduce cerebrospinal fluid. Others might develop hydrocephalus due to blockages caused by blood clots, such as cerebral hemorrhage or subarachnoid hemorrhage. There are also cases where hydrocephalus can occur alongside chronic conditions like subdural hematoma or epidural hematoma, depending on the specific clinical presentations of the patients.

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Can hydrocephalus be drained?

For patients with hydrocephalus, surgery is generally recommended. A common surgical option is the ventriculo-peritoneal shunt procedure, where a drain tube is placed in the patient's ventricular system. Through this surgery, excess cerebrospinal fluid is drained from the ventricular system to the patient's abdominal cavity, achieving a new balance. Most patients who undergo surgery achieve desirable outcomes, with initial symptoms and physical signs likely improving gradually. Over time, the patient's ventricular system may reduce in size, and may even return to normal. Therefore, for most patients with hydrocephalus, the surgical outcome is quite certain, and it is advised to opt for surgery at an early stage.