Back to Health A to Z. Hydrocephalus is a build-up of fluid on the brain. The excess fluid puts pressure on the brain, which can damage it. If your child has learning disabilities, they'll need extra support from their nursery or school to ensure their needs are being met. Acquired hydrocephalus can affect children or adults.
This can cause a number of long-term complications, such as: learning disabilities impaired speech memory problems short attention span problems with organisational skills vision problems, such as a squint and visual impairment problems with physical co-ordination epilepsy. If the hydrocephalus is not treated, the rise in pressure will damage the brain. Approximately 1 in every American babies are born with hydrocephalus. Acquired hydrocephalus Acquired hydrocephalus can affect children or adults. However, the name can be misleading, as some patients' CSF pressure does fluctuate from high to normal to low when monitored. Some experience loss of depth perception or have difficulty in judging distance or speed. Compounding this difficulty is the fact that some of the symptoms of NPH are similar to the effects of the aging process, as well as diseases such as Alzheimer's and Parkinson's. You may need adupts course of antibiotics to treat the infection and, in some cases, surgery may be required to replace Side effects of hydrocephalus in adults shunt. Some Bondage hantai with hydrocephalus may have problems with decision-making, logical thinking, organisational problems, and an inability to follow verbal Photography young girls nude forum, short-term memory difficulties, hydroxephalus passive behaviour.
Mature model in pantie. What is hydrocephalus?
People may have trouble picking up their feet, as if their feet are glued to the ground. According to the Life NPH websiteif the cause of the NPH is known, the reported success rate for the shunting procedure can be as high as 80 percent. For those who have externally adjustable or programmable valves, the balance of flow can be restored by re-setting Side effects of hydrocephalus in adults opening pressure. Complications that may Vagina verte with shunt systems include:. Their handwriting might also be quite poor and illegible, due to visual perception dysfunction. The majority of the NPH population is older than 60, and many of these people believe their symptoms are just part of the aging process. Those patients treated with ventriculoatrial VA shunts may develop generalized infection, which can quickly become serious. Although hydrocephalus often is described as "water on the brain," the "water" is actually CSF — a clear fluid surrounding the brain and spinal cord. Subdural hematoma occurs if blood from broken vessels in the meninges becomes trapped between the brain and skull. Much is said and written about intelligence, and particularly about IQ intelligence quotientin people with hydrocephalus. The symptoms of NPH usually get worse over time if the condition is left untreated. Reading a catalogue of the effects of hydrocephalus can be very alarming.
In hydrocephalus, the build-up of CSF can raise pressure inside the skull, which squashes surrounding brain tissue.
- Optional email code.
- The site navigation utilizes arrow, enter, escape, and space bar key commands.
- Hydrocephalus can be treated with a shunt system, and this treatment often includes complications.
- A ventriculoperitoneal VP shunt is a medical device that relieves pressure on the brain caused by fluid accumulation.
Hydrocephalus is the buildup of fluid in the cavities ventricles deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain. Cerebrospinal fluid normally flows through the ventricles and bathes the brain and spinal column. But the pressure of too much cerebrospinal fluid associated with hydrocephalus can damage brain tissues and cause a range of impairments in brain function.
Surgical treatment for hydrocephalus can restore and maintain normal cerebrospinal fluid levels in the brain. Many different therapies are often required to manage symptoms or functional impairments resulting from hydrocephalus. Seek emergency medical care for infants and toddlers experiencing these signs and symptoms:. Your brain floats in a bath of cerebrospinal fluid.
This fluid also fills large open structures, called ventricles, which lie deep inside your brain. The fluid-filled ventricles help keep the brain buoyant and cushioned. Hydrocephalus is caused by an imbalance between how much cerebrospinal fluid is produced and how much is absorbed into the bloodstream.
Cerebrospinal fluid is produced by tissues lining the ventricles of the brain. It flows through the ventricles by way of interconnecting channels. The fluid eventually flows into spaces around the brain and spinal column. It's absorbed primarily by blood vessels in tissues near the base of the brain. In many cases, the exact event leading to hydrocephalus is unknown.
However, a number of developmental or medical problems can contribute to or trigger hydrocephalus. Hydrocephalus present at birth congenital or shortly after birth may occur because of any of the following:. Long-term complications of hydrocephalus can vary widely and are often difficult to predict. If hydrocephalus has progressed by the time of birth, it may result in significant intellectual, developmental and physical disabilities. Less severe cases, when treated appropriately, may have few, if any, serious complications.
Adults who have experienced a significant decline in memory or other thinking skills generally have poorer recoveries and persistent symptoms after treatment of hydrocephalus.
Hydrocephalus care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Hydrocephalus is the buildup of fluid in the cavities ventricles deep within the brain.
Request an Appointment at Mayo Clinic. Brain ventricles Your brain floats in a bath of cerebrospinal fluid. Share on: Facebook Twitter. Show references Hydrocephalus fact sheet. National Institute of Neurological Disorders and Stroke. Accessed June 1, Daroff RB, et al. Brain edema and disorders of cerebrospinal fluid circulation. In: Bradley's Neurology in Clinical Practice. Philadelphia, Pa. American Association of Neurological Surgeons. Haridas A, et al. Hydrocephalus in children: Clinical features and diagnosis.
Accessed May 27, Merck Manual Professional Version. Hydrocephalus in children: Physiology, pathogenesis, and etiology. Hydrocephalus in children: Management and prognosis. What can parents expect during their infant's well-child visits? Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. June 24, Meningococcal vaccine: Who and when to vaccinate. Centers for Disease Control and Prevention. Related Brain ventricles Shunt system.
Mayo Clinic in Rochester, Minn. Mayo Clinic Marketplace Check out these best-sellers and special offers on books and newsletters from Mayo Clinic.
Do you like this page? A squint or other eye problems can exacerbate the problem. There are rare risks specific to VP shunting that can be serious and potentially life-threatening if left untreated, including:. In the meantime, there are things you can try to help calm or quiet your anxiety…. There is no correlation between the number of shunt revisions or the site of shunt placement and an increased risk of developing seizures.
Side effects of hydrocephalus in adults. The Effects of Hydrocephalus
Approximately one third of people with hydrocephalus have seizures at some time in their lives. A rise in intracranial pressure due to shunt blockage may trigger an epileptic seizure. Seizures sometimes occur after shunt revision. It is often just an isolated incident, but some people go on to develop epilepsy. Epilepsy is usually treated with anti-convulsing drugs and is the same for people with or without hydrocephalus. Some children with hydrocephalus may develop early puberty.
Preparation of the child for the onset of periods and sexual development needs to be handled sensitively. Eye problems may be the first sign of raised pressure in the brain or shunt blockage, so it is important to monitor the eyes. In some children with hydrocephalus their ability to use language is often ahead of their ability to understand it.
Their vocabulary can be good because they are able to imitate what they hear. If they do not understand fully what is said their response may be inappropriate.
A child with a language problem will pick out words they understand and guess the rest or give a stock answer.
Problems with upper limb control and hand skills are common in people with spina bifida and hydrocephalus. It is important to encourage the use of both hands, especially if one hand is weaker than the other.
Problems with fine finger movements are shown in everyday tasks such as fastening buttons, catching balls, screwing lids on jars, and using scissors, as well as handwriting. People with hydrocephalus often have problems with visual perception. Although they recognise objects, they find it difficult to understand their position and relationships.
A squint or other eye problems can exacerbate the problem. Some experience loss of depth perception or have difficulty in judging distance or speed. There may be a difficulty with scanning visual images, with consequences for reading, writing and drawing. Sometimes people with hydrocephalus are not aware of signals given by facial expressions in others. Perceptual difficulties are not the only problems associated with hydrocephalus.
Some people with hydrocephalus may have problems with decision-making, logical thinking, organisational problems, and an inability to follow verbal instructions, short-term memory difficulties, and passive behaviour.
All of these have major implications for adult life. Spatial awareness is the ability to understand the surrounding space and judge distance, height, width, size, and volume. Problems with spatial and visual perception are inter-related. It can affect the way people move about, e. Fear of tilting a wheelchair backward to climb a kerb or fear of the drop may also be apparent. People with hydrocephalus may have a fear of being left in a room alone, of venturing outside, or of long corridors.
Manual tasks might be carried out poorly e. Imaging studies are required to determine SVS, which is typically indicated by smaller than normal ventricles. For those who have externally adjustable or programmable valves, the balance of flow can be restored by re-setting the opening pressure. Subdural hematoma occurs if blood from broken vessels in the meninges becomes trapped between the brain and skull.
Multiloculated hydrocephalus is a located isolated CSF compartment in the ventricular system that is enlarged and not in communication with the normal ventricle. It may be caused by birth trauma, neonatal intraventricular hemorrhage, ventriculitis, shunt related infection, over drainage or other conditions.
This complication may be difficult to identify because it is typically seen in infants and children who may be neurologically compromised. Surgical treatments include multiple shunt placement, ventricular catheters with multiple perforations or openings, craniotomy and fenestration opening of the intraventricular loculations. Seizures sometimes occur in people with hydrocephalus. There is no correlation between the number of shunt revisions or the site of shunt placement and an increased risk of developing seizures.
Abdominal complications can occur in people with hydrocephalus treated with a shunt. Although ventriculoperitoneal VP shunts do not have fewer complications than ventriculoatrial shunts, the complications are less severe and have a lower mortality rate.
Shunt complications that develop in the peritoneum or abdominal area include peritoneal pseudocysts, lost distal catheters, bowel perforations and hernias. Complications of Shunt Systems. Complications of Shunt Systems Hydrocephalus can be treated with a shunt system, and this treatment often includes complications.
Adult-onset Hydrocephalus – Symptoms, Diagnosis and Treatments
The outlook of pediatric hydrocephalus has spectacularly improved over the past decades; however, the adult outcome is still poorly documented. Determining the healthcare profile of these patients is important in order to organize the management of this growing population. We decided to review our pediatric hydrocephalus database for pediatric patients treated for hydrocephalus and followed up into adulthood.
Our institution has a virtual monopoly for pediatric hydrocephalus, serving a four-million-plus population; the transition to adult care is also managed in the same institution. We retrospectively reviewed patients younger than 18 treated for hydrocephalus since and followed up beyond the age of We reviewed patients, with a mean initial age of In 81 patients Sixteen patients 3. Thirteen patients died in adult age, 5 of these dying of shunt-related causes.
Adults treated for hydrocephalus in childhood require a life-long follow-up. Late mortality is low but not null, morbidity is high, and many patients require shunt surgery during adulthood. The transition from child to adult neurosurgery needs to be organized for these vulnerable patients.
In our hospital, we have organized a long time ago a systematic follow-up of pediatric patients in the adult neurosurgery clinic when they become adults. We decided to review our clinical database in order to study the outcome of patients treated for hydrocephalus during childhood and followed up beyond their 20th birthday.
Our hospital is the sole referral center for pediatric neurosurgery, serving a four-million population area. Our patients have been logged prospectively in a database since the s, which became computerized in the s. The patients were followed up systematically in pediatric neurosurgical clinics. Our policy is to revise asymptomatic ruptured shunts whenever the patient is considered shunt-dependent, which is attested by a previous history of symptomatic shunt failure or a positive shuntogram patent shunt or badly tolerated ligation test [ 31 ].
Schooling was rated as: normal curriculum; shortened curriculum in a normal school; schooling with aides like support during classes, additional time for exams, etc. The remaining patients represent the study group.
These patients were male and female, the median age at first shunt implantation was The causes of hydrocephalus were tumor in The initial treatments were ventriculoperitoneal shunt in The median follow-up was During the period of follow-up, these patients underwent 1, reoperations mean, 2.
The surgical outcome after initial surgery is shown in Fig. Overall, 91 patients had not been reoperated yet at the last control, had at least one reoperation before reaching the age of 20, and 81 Five patients in the series died of shunt-related causes after the age of 20; in one of these, the diagnosis of shunt failure was delayed in part because the shunt had never been revised before. Over the whole series, the shunt-related mortality rate could be established at 4.
Actuarial event-free survival after the first surgery. Number of reoperations per patient. Shunt infection occurred 88 times in 71 patients 5. Latex allergy was recorded in 36 cases 7. Among survivors, 15 2. Mortality after the age of Karnofsky independence scale ratings were available in patients In actuarial analysis, the cumulated incidence of secondary epilepsy was 6.
Only 82 patients Pregnancy was recorded in 32 cases Distribution of Karnofsky independence score; Prevalence of the different sequels among the patients of the series. We also studied the overall outcome evaluated with the GOS according to the year of initial treatment, plotted in Fig. Overall outcome. However, patients treated in the s must have been older than the average at the time of initial treatment to meet the inclusion criteria, and their follow-up was also shorter, introducing important biases.
Schooling was documented in cases Among evaluable patients, In order to illustrate the discrepancy between neuropsychological testing, academic achievement, and social integration, we plotted these variables in Fig.
Comparison between IQ testing, schooling, and social integration. Normal IQ was defined as 80 or higher. Our series represents a large number of patients treated during childhood for hydrocephalus and followed up into adult age, based on a relatively stable population sample of four million.
Although the accrual of patients was prospective and consecutive, the collection of data for the present study was for a large part retrospective. This leads to some uncertainty, in particular over the real incidence of the different types of sequels, leading to likely underestimation of sequels, but also of the number of pregnant women. Finally, studying the adult outcome of patients treated at birth amounts to evaluating standards of care of two decades ago.
Obviously, having all patients filling prospectively a form dedicated to hydrocephalus, like the Hydrocephalus Outcome Questionnaire HOQ [ 16 , 24 ], is certainly the gold standard for this type of studies, but this is a huge undertaking and some time will pass before we can see the adult outcome.
For the time being, and with the aforementioned caveats, we think our data can be useful. Shunt malfunction is a permanent risk in patients treated with shunts, carrying risks of both morbidity and mortality. All studies of shunt outcome show similar biphasic survival curves; however, the incidence of very late obstruction is poorly documented in the literature. Our present study confirms that many patients shunted during childhood require reoperation when they are adults, some of them for the first time; it also shows that late malfunction in an unprepared patient can be fatal.
Regarding patients treated by endoscopy, the incidence of obstruction is markedly lower than with shunts; however, long-term data are even less clear; whatsoever, it is now certain that delayed obstruction of the stomy is a very serious threat as well [ 7 ]. In a previous study, we found that the yearly incidence of infections beyond the first postoperative year was 0. Among the sources of late shunt infection, abdominal complications are prevalent; in particular, the yearly incidence of bowel perforation by the peritoneal catheter was estimated at 0.
In the present study, shunt infection occurred after the age of 20 in 11 cases and was fatal in 1 case. Patients and their caretakers should be given information on this risk in order to organize prompt diagnosis and treatment.
Evidence of shunt dependence is provided by the occurrence of symptomatic shunt failure. When a patient who has never been revised before presents with an asymptomatic shunt rupture, the question arises of either a ruptured but still functional shunt or an obstructed shunt in a patient who has become at some point shunt-independent.
In any case, a broken shunt in an asymptomatic patient should not be taken as a proof of shunt independence, even with a wide gap between the shunt fragments [ 6 ]. In our practice, the answer to the question requires a shuntogram, catheter ligation if the shuntogram shows no flow, then shunt removal if the ligature is well tolerated.
In the present series, following this procedure resulted in shunt independence in only six cases; in four cases, the test failed to achieve shunt independence. Shunt independence can also be achieved through endoscopy [ 5 ]; however, in our series, shunt independence was achieved through endoscopy in only three of the seven attempts. Few studies focus on the long-term mortality in pediatric patients treated for hydrocephalus. Focusing on nontumoral hydrocephalus, Tuli and Casey found similar figures In our series, 6.
Patients with myelomeningocele were overrepresented in shunt-related mortality; as reported earlier, the excess risk being likely related to the Chiari malformation [ 29 ].
Unexpected death in a shunted patient should be considered shunt-related unless proved otherwise [ 13 ]. In a previous study, we noted that the only mean at our disposal to prevent such catastrophic outcome was systematic follow-up and revision of asymptomatic ruptured shunts [ 31 ]. The periodicity and modalities of this follow-up are open to debate and depend on the medical resources available.
In our series, Endocrine sequels are also common in hydrocephalic patients; in particular, disturbance of the gonadostimulin axis; although precocious puberty is a common finding during childhood [ 25 ], its relation to hypothalamic dysfunction and its predictive value for low fertility in adult life are poorly documented.
In the series published by Gupta, only Low fertility is also a reflection of the poor social life and isolation of many of these patients [ 8 ]. Epilepsy is common in hydrocephalic patients and is caused by the initial brain disease as well as the insertion of the catheter, as attested by the presence of epileptic foci on postoperative EEG [ 2 ]. In our series, we found similar figures in the early years after surgery; however, new cases of epilepsy became rare as the patients grew up.
Epilepsy has been correlated with a lower IQ [ 10 ] and has a negative impact on quality of life measured by the HOQ [ 16 ].
These result from congenital malformation or aggression or from the severity of hydrocephalus and subsequent complications. In our series, the figures special education in Among 82 patients followed up beyond the age of 16, Kokkonen found a normal intellectual functioning in Paulsen et al. We found a similar number of patients still studying Our Fig. Rare opinions are voiced, challenging the practice of systematic follow-up of hydrocephalus as a misuse of strained neurosurgical resources and proposing to dismiss the patients to pediatricians or general practitioners [ 14 ].
However, every now and then, grim stories are published as stark reminders that, without routine and apparently useless follow-up, terrible drama can strike [ 3 , 7 ]. Despite of this, opinions diverge over what happens when the patients become adults, and no guideline exists for the long-term follow-up.
However, we think that very long intervals between clinics may lead many patients to abandon follow-up altogether. In our experience, many patients are anxious to continue the regular follow-up in neurosurgery, and they grudgingly accept being transferred to an adult colleague by the pediatric neurosurgeon.
This holistic definition sets very high standards, which are rarely met. Knowledge of these different needs is useful in order to anticipate the process of transition. Patients who have no physical impairment need only a neurosurgical follow-up. Some need to be persuaded to continue this follow-up; conversely, others need to be encouraged to live a normal life and convinced that they should not be forbidden any activity because of their shunt. Generally, the follow-up of these patients has to tread a line between too much fear and too much confidence.