Treatment For Normal Pressure Hydrocephalus
Shunts may also be used for normal pressure hydrocephalus. However, shunts may not be suitable for some patients. Other procedures may be carried out to check suitability:
Lumbar puncture some of the cerebrospinal fluid is removed from the base of the spine. If this improves the patients gait or mental abilities, fitting a shunt will probably help.
Lumbar infusion test a needle is inserted through the skin of the lower back into the spine. Measurements are taken of CSF pressure as fluid is injected into the spine. Patients usually benefit from having a shunt fitted if their CSF pressure is over a certain limit.
What Are The Symptoms Of A Cerebrospinal Fluid Leak
Symptoms of a cerebrospinal fluid leak can include:
- Headache, which feels worse when sitting up or standing and better when laying down may come on gradually or suddenly
- Vision changes
- Hearing changes/ringing in ears
- Pain between the shoulder blades
- Arm pain
In addition to these symptoms, other symptoms unique to cranial CSF leaks include:
- Clear, watery drainage usually from only one side of the nose or one ear when tilting the head forward
- Salty or metallic taste in mouth
- Drainage down back of throat
- Loss of smell
Is Hydrocephalus Treatable
With early detection and appropriate intervention, the future for many is promising. Currently, the only form of treatment for hydrocephalus requires brain surgery. There are three forms of surgical treatment used to manage hydrocephalus.
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How Is A Leak Diagnosed
Since symptoms can suggest many potential issues, diagnosis is often a trial and error process based on an elimination of other possible causes. Diagnosis also includes a physical exam. An optical tube with a camera attached may be used to examine the nose. Detection may also involve:
- Imaging studies
- An attempt to collect fluid by having the patient lean forward and testing the sample to confirm that it is CSF
- The injection of a dye into the spinal canal to determine the location of the leak
Normal Pressure Hydrocephalus Symptoms
Symptoms of normal pressure hydrocephalus may mimic other conditions such as Parkinson’s disease, Alzheimer’s disease and Creutzfeldt-Jakob disease. Signs and symptoms of this type of hydrocephalus can include progressive mental impairment and dementia, problems with walking and dysfunction of bladder control. People with normal pressure hydrocephalus may complain of slow body movements.
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Hydrocephalus Present From Birth
Congenital hydrocephalus is when a baby is born with excess fluid in their brain.
Many babies born with hydrocephalus have permanent brain damage.
This can cause several long-term complications, such as:
If your child has learning disabilities, they’ll need extra support from their nursery or school to ensure their needs are being met.
What Are The Symptoms
The symptoms of hydrocephalus can vary significantly from person to person and mostly depend on age. Conditions other than hydrocephalus can cause similar symptoms so it is important to see a doctor to receive proper diagnosis and treatment.InfantsSigns and symptoms of hydrocephalus in infants include:
- a rapid increase in head size
- an unusually large head
Brain imaging and other testsTests to accurately diagnose hydrocephalus and rule out other conditions may include:
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How Is Hydrocephalus Treated
Currently, the only way to treat hydrocephalus is with brain surgery. There are two types of brain surgeries used to treat hydrocephalus:
- Shunt. The most common type of treatment for hydrocephalus is the surgical placement of a medical device called a shunt. A shunt is a flexible tube thats placed in your brain. It drains the excess CSF to another area of your body where it can be absorbed.
- Endoscopic third ventriculostomy : With this surgery, a small hole is made in the floor of your third ventricle. This creates a pathway for CSF to flow in and around your brain as it would normally. This procedure is generally performed in children over the age of 2.
Support For Normal Pressure Hydrocephalus
Coping with the symptoms of NPH can be difficult for both you and your family members. The condition affects every aspect of your life, including family relationships, work, financial status, social life, and physical and mental health. You may feel overwhelmed, depressed, frustrated, angry, or resentful. These feelings do not help the situation and usually make it worse.
This is why support groups were invented. Support groups are groups of people who are going through the same things and want to help themselves and others by sharing coping strategies.
Support groups meet in person, on the telephone, or on the internet. To find a support group that works for you, contact the organizations listed below. You can also ask your health care provider or behavior therapist, or go on the internet. If you do not have access to the internet, go to the public library.
For more information about support groups, contact the following agencies:
- Family Caregiver Alliance, National Center on Caregiving — 445-8106
- Hydrocephalus Association — 732-7040 or 598-3789
- National Hydrocephalus Foundation — 924-6666
- Hydrocephalus Support Group, Inc. — 532-8228
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What Causes A Cerebrospinal Fluid Leak
Many cases of cerebrospinal fluid leak have no known causes. This is called a spontaneous CSF leak. The following are other possible common causes:
- Head trauma or spine injury
- History of epidurals or spinal catheters
- Certain head and spine surgeries
- Epidural injection
- Skull base defects
- High pressure intracranial hydrocephalus
- Underlying and untreated intracranial hypertension
- Underlying and untreated connective tissue diseases, such as Ehlers-Danlos and syndromes
- Bone spurs along the spine
How Does Hydrocephalus Happen
Cerebrospinal fluid is saltwater that’s made inside the ventricles. It flows around the brain and spinal cord, cushioning them. It also sends nutrients to the brain and takes away waste. Then it’s absorbed into the bloodstream, and new, fresh CSF takes its place.
Hydrocephalus can happen if:
- The flow of CSF is blocked .
- Not enough CSF is absorbed into the bloodstream .
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Hydrocephalus Diagnosis & Testing
Hydrocephalus may be diagnosed before birth by prenatal ultrasound, a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. In many cases, hydrocephalus doesnt develop until the third trimester of the pregnancy and, therefore, may not be seen on ultrasounds performed earlier in pregnancy.
The diagnosis of congenital hydrocephalus may be made at birth and after diagnostic testing. During the examination, the doctor obtains a complete prenatal and birth history of the baby. He or she may also ask if theres a family history of hydrocephalus or other medical problems. The doctor will also ask about developmental milestones in older babies since hydrocephalus can be associated with developmental delay. Developmental delays may require further medical follow-up for underlying problems.
The babys head may appear larger than normal. A measurement of the circumference of the babys head is taken and compared to a graph that can identify normal and abnormal ranges for a babys age.
Diagnostic tests that may be performed to confirm the diagnosis of hydrocephalus include:
Hydrocephalus Treatments At Choc
The goal of treatment is to reduce the pressure in the babys head and to properly drain the cerebral spinal fluid . Occasionally, medications or procedures to draw off the extra CSF may be used.
Surgery may be needed for some cases of hydrocephalus. Surgery usually involves placing a mechanical shunting device into the babys head to help drain the extra CSF from the brain and redirect the extra fluid to another part of the body to be absorbed. A common type of shunt is the ventriculoperitoneal shunt. This directs the fluid into the abdominal cavity.
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How Is Hydrocephalus Diagnosed
If you suspect that you or your child has hydrocephalus, your doctor will perform a physical exam to look for signs and symptoms. In children, doctors check for eyes that are sunken in, slow reflexes, a bulging fontanel, and a head circumference that is larger than normal for their age.
Your doctor may also use an ultrasound to get a closer look at the brain. These tests use high-frequency sound waves to create images of the brain. This type of ultrasound can only be done in babies whose fontanel is still open.
Magnetic resonance imaging scans can be used to look for signs of excess CSF. MRIs use a magnetic field and radio waves to make a cross-sectional image of the brain.
Computerized tomography scans can also help diagnose hydrocephalus in children and adults. CT scans use several different X-rays to form a cross-sectional image of the brain. These scans can show enlarged brain ventricles that result from too much CSF.
Treatment Of Fluid Behind The Retina
- Medications such as corticosteroids or anti-inflammatory drugs aim to quell inflammation. These can come in the form of drops, pills, or even dispersed via extended-release devices in some cases.
- Sometimes, it may be necessary to use a surgical approach such as a vitrectomy in which the jelly-like substance that normally fills the eye is removed.
- In some cases, such as in diabetic retinopathy, laser treatment may stop blood vessels from leaking and reduce retinal swelling.
- If you have macular edema, you may be treated with what’s known as anti-VEGF injections. Vascular endothelial growth factor is a protein that leads to the production of new blood vessels. With macular edema, these blood vessels may leak. The use of anti-VEGF can slow the production of these new blood vessels.
- Making lifestyle changes, such as controlling blood sugar levels in the case of diabetic retinopathy, should also be kept in mind when considering how to help alleviate fluid behind the retina.
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What Is The Outlook For A Person With Hydrocephalus
The outlook for someone with hydrocephalus depends largely on the extent of the symptoms. Many children experience lifelong brain damage. By working with professionals including pediatricians, special education teachers, mental health providers, occupational therapists, developmental therapists, and pediatric neurologists, children can learn to manage their disability and lessen the lifelong effects.
Adults with severe symptoms of hydrocephalus might need to work with occupational therapists. Others may require long-term care. Some might need the care of medical specialists who focus on dementia.
The long-term effects of this condition vary widely, depending on individual circumstances. Talk to your doctor for a more case-specific outlook.
What Causes Brain Swelling
Injury, other health problems, infections, tumors, and even high altitudes — any of these problems can cause brain swelling to occur. The following list explains different ways the brain can swell:
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What Are Possible Treatment Options For Csf Leaks
Initial treatment often includes rest and drinking plenty of water to stay hydrated, which encourages natural healing of the hole. Steroids are sometimes recommended to further facilitate healing. Surgical intervention may include an injection of the patients own blood into the epidural space to restore fluid pressure. If this isnt effective, graft material may be used to seal the leak. A lumbar drain is sometimes placed in the lower back to reduce pressure around the area of the CSF leak. Though spinal fusion surgery is not necessary in this instance, there are also various alternatives to spinal fusion. Beverly Hills patients should see a spine specialist as soon as possible if they are experiencing any of the symptoms of a CSF leak.
Patients are typically instructed to avoid excessive straining, including forceful coughing and sneezing, for 1 to 2 weeks during attempts to allow natural healing to correct the problem. There is no effective way to prevent a CSF leak, although it may help to take steps to ease trauma around the upper spine and neck as much as possible when engaging in activities that place stress on the base of the skull or upper spine.
In severe cases, Beverly Hills spine surgery can be a good option to relieve your pain.
What Causes Hydrocephalus
Hydrocephalus may be present at birth or may develop over time as a result of injury or disease . Except for hydrocephalus secondary to physical obstruction of CSF passages within the brain or skull by blood or tumor, the exact causes of hydrocephalus are still not well understood.
Congenital hydrocephalusBabies may be born with hydrocephalus or develop the condition shortly after delivery. In these cases, hydrocephalus may be caused by:
- inherited genetic abnormalities that block the flow of CSF
- developmental disorders such as those associated with birth defects in the brain, spine, or spinal cord
- complications of premature birth such as bleeding within the ventricles
- infection during pregnancy such as rubella that can cause inflammation in the fetal brain tissue.
AcquiredhydrocephalusCertain factors can increase the risk of developing hydrocephalus at any age, including:
- brain or spinal cord tumors
- infections of the central nervous system such as bacterial meningitis
- injury or stroke that causes bleeding in the brain.
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How Can I Protect My Head
To protect the brain, keep these tips in mind as you go about your daily activities:
- Use a helmet when biking, skating, playing contact sports, or performing other activities in which you might fall and hit your head.
- Wear seat belts properly when driving or riding in vehicles.
- Make sure you are doing all you can to control high blood pressure and heart disease.
- Avoid smoking.
- When traveling to high elevations, take your time — allow your body to adjust to the altitude.
Is There Any Treatment
Hydrocephalus is most often treated with the surgical placement of a shunt system. This system diverts the flow of CSF from a site within the central nervous system to another area of the body where it can be absorbed as part of the circulatory process. A limited number of patients can be treated with an alternative procedure called third ventriculostomy. In this procedure, a small hole is made in the floor of the third ventricle, allowing the CSF to bypass the obstruction and flow toward the site of resorption around the surface of the brain.
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How Is Normal Pressure Hydrocephalus Treated
A commonly used treatment for NPH is surgery to place a tube, called a shunt, into the brain to drain the excess fluid. The shunt is usually inserted into a ventricle in the brain and then passed under your skin from your head through your neck and chest to your abdomen. The extra fluid in your brain flows through the shunt into your abdomen, where your body absorbs it. The ventricles in your brain may then go back to their normal size. The shunt stays in place as long as there is too much CSF in the brain.
Implanting a shunt doesnt work for everyone, but some people do benefit from it. Getting prompt diagnosis and treatment helps improve your chances of a good outcome.
Older Child Or Adult Symptoms
Symptoms of hydrocephalus in adults and children may present as nausea, vomiting preceded by a headache, double or blurred vision, “sunsetting” sign, unsteady balance, problems with coordination, difficulty walking, urinary incontinence, drowsiness, lethargy, changes in personality or the capability to think, reason and remember.
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Hydrocephalus In Older People
Older people can sometimes develop normal pressure hydrocephalus after a brain injury, bleeding in the brain or an infection. But it’s often not clear why NPH happens.
Page last reviewed: 21 January 2020 Next review due: 21 January 2023
How Common Is A Cerebrospinal Fluid Leak
Cerebrospinal fluid leaks are a rare event. Researchers estimate that they occur in about 5 in every 100,000 people. However, they also believe that this is an underestimate and that the true number of people affected remains unknown. They are mostly found in people in their 30s and 40s. CSF leaks are commonly misdiagnosed as migraines, other headache disorders or sinusitis.
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