Hydrocephalus: diagnosis and treatment

What is hydrocephalus

Hydrocephalus is a complex malformation of the CNS, characterized by an accumulation of CSF in the cerebral and / or meningeal ventricular space. severe: mental alterations, convulsions, increased head circumference, intellectual deficits and mood disturbances are just some of the countless 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: anamnesis, general physical examination, neurological test, brain imaging test. Let's see them in more detail.

• Neurological test for hydrocephalus: it is performed in order to analyze reflexes, muscle strength and tone, sense of touch, hearing, coordination capacity and mental integrity.
• Imaging test:
  • Brain magnetic resonance: useful for evaluating the possible distension of the ventricles, caused by the accumulation of CSF. The MRI test is also indicated to trace the triggering cause of hydrocephalus and to evaluate the dynamics of the CSF flow.
  • Brain ultrasound (ultrasound test): indicated to ascertain a suspicion of hydrocephalus in the newborn. The procedure carries virtually no risk to the patient. Brain ultrasound can diagnose hydrocephalus even before birth, during a simple routine ultrasound.
  • Computed tomography (X-ray test): The test is painless, and takes approximately 20 minutes. Typically, the child undergoing this diagnostic test is mildly sedated.
• Arteriography: This diagnostic test is also sometimes used to ascertain a suspicion of 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.
• Intracranial pressure detection: the test is performed by lumbar puncture (or spinal tap). This diagnostic procedure consists in taking a CSF sample, using a needle inserted between the L3-L4 or L4-L5 vertebrae.

Differential diagnosis

Considering the numerous symptoms associated with hydrocephalus, it is understandable that the diagnosis can be confused with other pathologies with similar symptoms. For this reason, in order to choose the most appropriate treatment, the differential diagnosis is necessary and indispensable.
The differential diagnosis must be made with:

• Intracranial epidural abscess
• Frontal lobe dementia
• Epidural and subdural hematoma
• Childhood migraine
• Intracranial hemorrhage
• Subdural empyema
• Epilepsy
• Sudden loss of vision
• Infections
• Mental delay
• Brain tumors

Cures and treatments

Untreated hydrocephalus is often fatal within the first 4 years of life.
Hydrocephalus requires prompt treatment, to be started immediately after the diagnostic assessment: by doing so, it is possible to minimize the risk of complications.

• 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.

Treatment for hydrocephalus is exclusively surgical: based on the severity of the hydrocephalus, the patient's general state of health and the triggering cause, one of three possible interventions can be used.

1. SURGICAL SHUNT FOR HYDROCEPHALUS: The most common treatment of all for hydrocephalus is the surgical insertion of a drainage system, called shunt. The procedure 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 the 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. Typically, hydrocephalus sufferers require surgical shunt for life. This treatment, foolproof at first glance, could create complications: a mechanical malfunction or an infection could send the system into a tailspin, thus interrupting the correct drainage. In case of infection, antibiotic treatment is necessary.
2. VENTRICULOSTOMY FOR HYDROCEPHALUS: 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 CSF to pass outside the brain. Over time, the intraventricular hole may close: in similar circumstances, the symptoms of hydrocephalus reappear.
3. Less frequently, patients with hydrocephalus undergo cauterization (burning) or removal of the CSF-producing portions of the brain.

After any curative treatment for hydrocephalus, the patient must constantly undergo 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 carefully managed and monitored at an early age, thus avoiding complications.
Prognosis often depends on the cause of the hydrocephalus.

Other articles on "Hydrocephalus: diagnosis and treatment"

1. Hydrocephalus - Symptoms
2. Hydrocephalus