Will hydrocephalus cause the fontanel to bulge?

Written by Liu Dong Yang
Neurosurgery
Updated on January 09, 2025
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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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Written by Jiang Fang Shuai
Neurosurgery
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Causes of Hydrocephalus

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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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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Written by Jiang Fang Shuai
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Early manifestations of infant hydrocephalus

Infant hydrocephalus initially manifests as an enlarged head, beginning from birth with progressive increase in head circumference that is disproportionate to body growth. Upon examination, bulging fontanelles, thin scalp, and clearly visible scalp veins can be observed, with widened or even separated sutures. Additionally, due to increased intracranial pressure, symptoms such as irritability, recurrent vomiting, refusal to eat, abnormal behavior, and seizures may present as early indicators.

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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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How to alleviate pain from hydrocephalus?

For patients with hydrocephalus, if there is significant pain, it is mostly caused by increased intracranial pressure, often seen in progressive hydrocephalus, or obstructive hydrocephalus. As the cerebrospinal fluid gradually increases and accumulates, it leads to the expansion of the ventricular system and causes extensive hydrocephalus, accompanied by gradually increasing intracranial pressure. To alleviate the pain, one might consider taking oral long-acting analgesics to help relieve the pain. Additionally, the use of mannitol or performing a lumbar puncture to release a small amount of cerebrospinal fluid may be considered to ease the pain. However, the key is to achieve the ultimate resolution of the disease through surgery.