Today, October 25 2017, is World Hydrocephalus Day.

Hydrocephalus is got from the combination of two words; ‘hydro’ which means water and ‘cephalus’ which means head. Hydrocephalus literally means water in the head. Then which part of the head?

Hydrocephalus is the build-up of cerebrospinal fluid (CSF) in the subarachnoid space of the brain, due to impaired circulation or absorption of the fluid. It can either be of the communicating (non-obstructive) type, which means that the flow of CSF is obstructed after it exits the ventricles of the brain or it can be of the non-communicating (obstructive) type which means that the flow of CSF is obstructed within the ventricles. 

The non-communicating type majorly occurs in children with conditions like aqueductal stenosis, Arnold Chiari malformation, Dandy- Walker syndrome etc. The communicating type occurs in both adults and children with conditions like subarachnoid haemorrhage; mass lesions like haematomas and brain abscess as well as in pneumococcal and tuberculous meningitis.

Hydrocephalus may be congenital, seen in children (majorly due to genetic abnormalities like aqueductal stenosis, Chiari’s malformations) or acquired, seen both in adults and children. Causes of acquired hydrocephalus include traumatic head injury, stroke especially subarachnoid haemorrhage, tumour in the brain, meningitis, brain abscess etc.

Some types of hydrocephalus constitute medical/ surgical emergencies and require prompt medical attention to avoid herniation of the brain (coning). Causes of such are subarachnoid haemorrhage and haematomas. Contrast this with normal pressure hydrocephalus, seen majorly in the elderly, due to brain atrophy which is more benign. 

Features of hydrocephalus

These can vary with age. In adults it can present with symptoms and signs of raised intracranial pressure which include headache, vomiting, blurred vision, lethargy, drowsiness, unconsciousness, gait abnormality, memory loss, changes in personality and cognition, urinary frequency and/or incontinence as well as raised blood pressure.

Focused neurological examination can often identify tell tale signs consistent with the presence of a hydrocephalus. Thus early presentation to a neurologist can lead to early recognition of the condition and thus the institution of appropriate life saving measures.

The availability of neuro-imaging modalities (such as CT and MRI) has been immensely helpful in the evaluation of hydrocephalus. The service of the neurosurgeon often is needed in the comprehensive management of hydrocephalus cases in the adult. 

So, as we remember actual and potential cases of hydrocephalus, let us remember that hydrocephalus is neither synonymous with macrocephalus nor megaencephalus.

Love and care for that hydrocephalus patient!

@Dr. Chidimma Rhoda Nwutobo.