Hydrocephalus, sometimes called hydrocephalus, is a condition in which there is an abnormal accumulation of cerebrospinal fluid (CSF) in the cavities of the brain, the so-called ventricles. This leads to the ventricles dilating and can cause pressure or disturbances in brain function.
The condition can occur at any age, but in adults and the elderly a particular form is common: normal pressure hydrocephalus (NPH). In NPH, the pressure in the cerebrospinal fluid is often normal when measured, even though the amount of fluid is elevated.
Common symptoms of hydrocephalus and NPH
The symptoms of hydrocephalus vary depending on age and underlying cause. In normal pressure hydrocephalus, a characteristic triad of symptoms is often seen:
- Difficulties in walking – unsteady gait, wide-tracked walking or difficulty lifting the feet.
- Cognitive impairment – memory problems, slow thinking, difficulty concentrating.
- Urinary incontinence – frequent urges or difficulty holding urine.
Symptoms often develop gradually and can be misinterpreted as normal aging or other conditions such as dementia or Parkinson's disease.
When should hydrocephalus be suspected?
Hydrocephalus, especially NPH, should be considered in people who develop gait difficulties in combination with cognitive impairment and/or urinary problems. Since the condition is treatable in some cases, early identification is important.
How is hydrocephalus diagnosed?
The investigation of hydrocephalus usually begins with a clinical assessment and neurological examination. Imaging is central to the diagnosis.
MRI brain is the most important examination when hydrocephalus is suspected. With an MRI scan, you can:
- Identify dilated ventricles.
- Assess the structure of the brain and rule out other causes of the symptoms.
- Strengthen the suspicion of normal pressure hydrocephalus.
In some cases, computed tomography (CT) is also used, but MRI provides more detailed information and is preferable when possible.
Causes of hydrocephalus
Hydrocephalus occurs when the balance between production, circulation and absorption of cerebrospinal fluid is disrupted. Causes may include:
- Impaired resorption of cerebrospinal fluid (common in NPH).
- Previous cerebral hemorrhage or meningitis.
- Trauma to the head.
- Tumors or cysts that block the flow of fluid.
In normal pressure hydrocephalus, the cause is often unclear, and the condition is then called idiopathic NPH.
Treatment and follow-up
Treatment of hydrocephalus depends on the type and severity. In NPH, surgical treatment may be appropriate.
- Shunt surgery – a thin tube (shunt) drains excess fluid from the brain to the abdominal cavity.
- Follow-up of symptoms and shunt function.
- Rehabilitation, such as physiotherapy for walking difficulties.
Many patients with NPH experience improvement in walking ability and quality of life after treatment, especially if the diagnosis is made in time.