What is hydrocephalus
Hydrocephalus is a complex CNS malformation characterized by an accumulation of CSF in the cerebral and / or meningeal ventricular space. In hydrocephalus, the exaggerated and pathological collection of cerebrospinal fluid causes an increase in intracranial pressure, in turn responsible for serious disorders: psychic alterations, convulsions, increased head circumference, intellectual deficits and mood disorders are just some of the innumerable symptoms induced by hydrocephalus.
Early diagnosis and therapeutic treatments are essential to avoid tragic consequences and improve, as much as possible, the quality of life of patients affected by this terrible disease.
Diagnosis
The diagnosis of hydrocephalus consists in the careful clinical evaluation and in the use of various instrumental investigations: medical history, general physical examination, neurological test, brain imaging test. Let's look at them in more detail.
- Neurological test for hydrocephalus: it is performed in order to analyze reflexes, strength and muscle tone, sense of touch, hearing, ability to coordinate and mental integrity.
- Imaging test:
- Brain magnetic resonance: useful for assessing possible distension of the ventricles, caused by the accumulation of CSF. The MRI test is also indicated for tracing the cause of the hydrocephalus and evaluating the dynamics of the CSF flow.
- Brain ultrasound (ultrasound test): indicated to ascertain a suspected hydrocephalus in the newborn. The procedure carries almost no risk to the patient. Cerebral ultrasound can diagnose a state of hydrocephalus even before birth, during a simple routine ultrasound.
- Computed tomography (X-ray test): the test is painless, and lasts about 20 minutes. Generally, the child undergoing this diagnostic test is mildly sedated.
- Arteriography: this diagnostic test is also sometimes used to ascertain a suspected hydrocephalus. It consists in the radiological study of the morphology of the arteries, carried out by injection - in the same artery to be analyzed - of a contrast liquid.
- Endocranial pressure detection: the test is performed by lumbar puncture (or rachicentesi). This diagnostic procedure consists in taking a CSF sample, using a needle inserted between the L3-L4 or L4-L5 vertebrae.
Differential diagnosis
Given the numerous symptoms associated with hydrocephalus, it is understandable that the diagnosis can be confused with other pathologies of similar symptomatology. For this reason, in order to choose the most appropriate cure, the differential diagnosis is necessary and indispensable.
The differential diagnosis must be set with:
- Intracranial epidural abscess
- Dementia of the frontal lobe
- Epidural and subdural hematoma
- Infant migraine
- Intracranial hemorrhage
- Subdural empyema
- Epilepsy
- Sudden vision loss
- Infections
- Mental delay
- Brain tumors
Cures and treatments
Untreated hydrocephalus is often fatal within the first 4 years of life.
Hydrocephalus requires timely care, to be started immediately after the diagnostic assessment: by doing so, the risk of complications can be minimized.
- If the treatment is started before a worsening of the patient's clinical picture, irreversible brain damage can be prevented, and life prospects are good.
The treatment for hydrocephalus is exclusively surgical : based on the severity of the hydrocephalus, the patient's general health and the cause, it is possible to use one of the three possible interventions.
- SURGICAL SHUNT FOR HYDROCEPHALUS: the most common treatment ever for hydrocephalus is the surgical insertion of a drainage system, called a shunt . The operation is performed as follows: one end of a long flexible tube with a valve is placed in a cerebral ventricle. The opposite end of the tube is placed in another anatomical location (usually, abdomen or heart compartment). The positioning of this flexible tube improves the dynamics of the cerebrospinal fluid: in this way, the excess liquor can be reabsorbed more easily. Generally, people with hydrocephalus need a surgical shunt for life. This treatment, at first glance infallible, could create complications: a mechanical malfunction or an infection could cause the system to go haywire, thus interrupting the correct drainage. In case of infection, antibiotic treatment is required.
- VENTRICOLOSTOMIA PER IDROCEFALO: this is a complex surgical procedure reserved for a small number of hydrocephalus patients. Using a micro-camera, the surgeon will make a small hole in one of the cerebral ventricles (or between two ventricles), thus allowing the passage of the liquor outside the brain. Over time, the intraventricular hole may close: in such circumstances, the symptoms of hydrocephalus reappear.
- Less frequently, patients suffering from hydrocephalus are subjected to cauterization (burning) or removal of cerebral portions that produce liquor.
After any curative treatment for hydrocephalus, the patient must undergo constant routine checks to manage the symptoms of the disease and any complications.
Let us briefly recall that many congenital anomalies can be diagnosed even before the baby is born; therefore, diseases such as hydrocephalus can be accurately managed and monitored at an early age, thus escaping from complications.
The prognosis often depends on the cause that originated the hydrocephalus.
