Hydrocephalus

Hydrocephalus is the abnormal accumulation of cerebrospinal fluid (CSF) in the brain’s ventricles, leading to ventricular enlargement and increased intracranial pressure. This condition disrupts normal CSF circulation, which typically flows through the brain’s ventricles and is absorbed into the bloodstream. When blockages occur or the body produces too much fluid, CSF builds up, enlarging the ventricles and potentially compressing brain tissue.

Hydrocephalus is classified as communicating (when obstruction occurs outside the ventricles) or noncommunicating / obstructive (when obstruction occurs within the ventricles). Rare cases result from excessive CSF production.

Congenital Hydrocephalus

Congenital hydrocephalus, which is particularly relevant to birth injuries, occurs in approximately 2 to 3 per 1,000 live births. It results from malformations that develop in the womb (for example, aqueduct of Sylvius stenosis) or from prenatal infections such as toxoplasmosis. In infants, this condition often causes head enlargement because the skull bones have not yet fused.

The severity of congenital hydrocephalus depends on the duration and extent of ventriculomegaly. If left untreated, it can potentially lead to brain damage, convulsions, and intellectual disability.

Acquired Hydrocephalus

Acquired hydrocephalus develops later in life and can result from:

• Tumors
• Strokes
• Head injuries
• Infections
• Hemorrhage
• Other trauma

Idiopathic Normal Pressure Hydrocephalus (iNPH)

In adults, idiopathic normal pressure hydrocephalus (iNPH) features enlarged ventricles without markedly elevated intracranial pressure. It commonly presents with a triad of symptoms known as Hakim’s triad:

1. Gait disturbance
2. Cognitive impairment
3. Urinary incontinence