Hydrocephalus Clinical Manifestations

Written by Jiang Fang Shuai
Neurosurgery
Updated on September 11, 2024
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In adults, hydrocephalus can be of the normal pressure type, mainly characterized by unsteady gait, slow responses, urinary and fecal incontinence, among others. There is also high-pressure hydrocephalus, which mainly presents as increased intracranial pressure, with the most common symptoms being headache, vomiting, papilledema, and ataxia. In children and infants, hydrocephalus has its own characteristics. In addition to some of the adult symptoms, there are also anomalies such as an abnormally increased head size, bulging fontanelles, "sunset" eye sign, intellectual and cognitive impairments, decreased vision, visual field defects, decreased hearing, epilepsy seizures, and more.

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Neurosurgery
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How should hydrocephalus be treated?

Treatment of hydrocephalus must be specific to the patient's condition, as different cases of hydrocephalus require different treatment approaches. For some mild cases of hydrocephalus without obvious clinical symptoms, the focus is on observation or the use of internal medicine to improve cerebral circulation and neuroprotective medications. However, if symptoms emerge later and significantly affect daily life, shunt surgery from the cerebral ventricles to the abdominal cavity is performed for chronic hydrocephalus, aiming to alleviate the patient's suffering. In cases of acute hydrocephalus caused by cerebral hemorrhage or subarachnoid hemorrhage, treatment might involve the use of neuroendoscopy to create a ventriculostomy at the floor of the third ventricle or external ventricular drainage. Thus, treatment is determined based on the specific circumstances.

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Neurosurgery
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How to deal with hydrocephalus?

The treatment of hydrocephalus must clearly identify the severity of the condition. Hydrocephalus can be categorized into acute and chronic types. In cases of acute hydrocephalus, emergency ventricular puncture drainage surgery is required, otherwise, it may cause brain herniation leading to death. For chronic hydrocephalus, it is crucial to distinguish whether it is communicating hydrocephalus or obstructive hydrocephalus. For obstructive hydrocephalus, treatment options include creating a patency in the cerebral aqueduct and third ventriculostomy. For other types of hydrocephalus, ventriculoperitoneal shunt surgery can be performed. Therefore, it is essential to clearly determine the type of hydrocephalus to fundamentally select the appropriate surgical methods and instruments.

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Can hydrocephalus heal itself?

Hydrocephalus often does not heal on its own and is generally classified into different types, such as symptomatic hydrocephalus and asymptomatic hydrocephalus, obstructive hydrocephalus and non-obstructive hydrocephalus, communicating hydrocephalus, and non-communicating hydrocephalus, among others. Relatively speaking, patients with obstructive symptomatic hydrocephalus usually exhibit a progressively worsening condition. Without timely and effective treatment, patients may experience significant headaches, dizziness, nausea, vomiting, accompanied by motor dysfunction, difficulty walking, urinary and fecal incontinence, and other clinical manifestations. For these patients, early surgical intervention is advisable, as they often cannot heal on their own, and their condition will progressively worsen.

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Hydrocephalus MRI manifestations

For patients with hydrocephalus, an examination using cranial MRI often shows significant dilation of the ventricular system, especially in patients with communicating hydrocephalus, where the entire ventricular system can appear significantly dilated. Once such a condition is discovered, it is advisable to promptly visit a local hospital and consult a neurosurgeon to help assess the current situation, mainly to determine the primary cause of the hydrocephalus, as targeted treatment can only be conducted once the cause is identified. For severe cases of hydrocephalus, surgery is generally recommended, and clinically, a ventriculoperitoneal shunt procedure is commonly chosen.

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What is hydrocephalus shunt?

Patients with hydrocephalus usually require shunt surgery, among which the most common is the ventriculoperitoneal shunt. The shunt tube used in this surgery typically features a reservoir, often referred to by patients as a "water basket". Patients are frequently required to press this reservoir to promote the excess cerebral spinal fluid to flow through the shunt tube into the abdominal cavity, where it is absorbed by the omentum. If the reservoir is not pressed, the shunt tube may become blocked, potentially requiring the surgery to be performed again.