This is a condition in which there is abnormal amount/circulation of cerebral spinal fluid (CSF) in the brain cavities called ventricles caused by overproduction or blockage of flow. This results in increased pressure in the brain giving various symptoms stated below. Sometimes it may occur in adults but with normal pressures (normal pressure hydrocephalus).

Who gets it?
Anyone can develop hydrocephalus ranging from the unborn baby to the very old. However it is more common in babies and young children where it usually presents with a rapidly growing head (big head).

Why do some people get it?
Sometimes a cause for the hydrocephalus cannot be found. In the majority of cases however tests are done that helps to find a cause. The causes range from inherited cases (X linked hydrocephalus) to acquired cases. The acquired causes include infections, nutrient deficiencies in the mother (folate deficiency), birth defects, brain cysts and brain tumours. Head injuries and some types of strokes (ventricular bleeds) can also cause hydrocephalus. These ventricular bleeds can occur with vascular abnormalities and trauma which may also happen in premature babies during delivery.

How can I prevent it?
Preventing, identifying and treating infections early in both the mother and the child can prevent those caused by infections especially of the brain (meningitis). Women of reproductive health wishing to have babies should be on a balanced diet and if at risk of an unbalanced diet they should take folate tablets which can be prescribed by their doctors. These tablets should be taken before a woman is pregnant. By the time a woman misses her first period the critical time when folate is required for brain development will be over hence it will be too late. And the baby may be at risk for neural tube defects which may include spina bifida and hydrocephalus. Safety measures to prevent head injury will reduce hydrocephalus cases.

How is it diagnosed?
Children usually present with a head that is growing at a rate that is faster than normal. If this is suspected the head circumference can be measured at a clinic and plotted on a chart to see if it is abnormal. Other symptoms include a bulging fontanel (nhova yakakwirira), seizures, irritability, regression or delays in development. In older children and adults they can present with headaches, difficulty in walking, loss of athletic abilities, decrease in mental capabilities, change in personalities. All age groups can present with vomiting and lethargy. With these symptoms an ultra sound scan of the head can be done is the fontanels are still open. Pictures of the brain can be taken with computer tomography (CT) or magnetic resonance imaging (MRI). The patient is referred to a neurosurgeon (brain surgeon) for further management.

When to seek treatment?
When you notice any of the above symptoms or become pregnant please visit a doctor. Early treatment is advised to have better outcome.

What treatment is available?
The goal of treatment is to eliminate the cause if possible +/- provide alternate routes for the flow of CSF (brain water). Brain tumours can be removed surgically and infections treated with medicine. If there is a clear blockage to flow of CSF it can be unblocked or an alternate pathway opened up by endoscopic ventriculostomy. This is where a small hole is made in the skull and instruments introduced through the hole to open up channels for better flow of CSF. When this is not feasible CSF can be diverted to the veins, chest cavity or more commonly the abdomen through the use of shunts. These are small tubes that are inserted into the ventricles (brain cavities) and channelled below the skin usually into the abdominal cavity. The main problems with a shunt are that it can be blocked or infected, which may warrant revision of the shunt.

Will an affected person have a normal life?
Outlook depends on the cause, associated conditions and time to treatment. It ranges from a near normal life to severe disability and mental retardation. Half of babies with hydrocephalus will have normal intelligence. Most will have problems with vision and memory. The other problems may be related to the associated condition and causes.

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