Adult Hydrocephalus

Hisdocephaly is the enlargement and enlargement of the chambers or ventricles ( ventricles ) in the brain tissue containing cerebrospinal fluid as a result of the increase in this fluid. In normal healthy individuals, cerebrospinal fluid is produced by specialized cells in these chambers, and is reabsorbed by circulating around the brain chambers and the shell of the brain and the spinal cord. As a result of increased production of this fluid, decreased absorption or a blockage in the pathways from the place where it is produced to the area where it is absorbed, fluid accumulation in the brain ventricles may increase and hydrocephalus may develop.

Hydrocephalus can occur at any age. Hydrocephalus in adults has slightly different characteristics than childhood hydrocephalus. Adult hydrocephalus may develop after tumor and/or brain hemorrhage and trauma . Another special type of hydrocephalus, normal pressure hydrocephalus, also occurs in adults (aka Hakeem -Adams syndrome ).

Post-Tumor Hydrocephalus

This can be seen especially in tumors that compress or settle in the cerebrospinal fluid spaces and block the fluid flow pathways. In these cases, removal of the tumor is an effective method in the treatment of hydrocephalus as it will open the fluid flow pathways. However, the vestibular The contents of some special tumors such as schwannoma , epidermoid tumor may cause hydrocephalus. In these cases, hydrocephalus may not heal even if the tumor is surgically removed. In this case, it may be necessary to treat hydrocephalus separately.

Post-Bleeding Hydrocephalus

After the cerebrospinal fluid is secreted from the ventricles in the brain, it circulates around the brain and around the spinal cord and is absorbed through small canals. The location of the cerebrospinal fluid is between the brain and the arachnoid membrane, which is one of the membranes covering the brain. Bleeding into the cerebrospinal fluid almost always mixes with the chambers where this fluid is located and all the fluid in the channels where this fluid circulates, no matter where it comes from. After these hemorrhages, called subarachnoid hemorrhage (SAH), hydrocephalus develops due to the obstruction of fluid flow by blood and blood products or the obstruction of small channels that provide fluid absorption, thus preventing fluid absorption. If this bleeding is due to a vessel bubble (aneurysm), the rate of hydrocephalus development is higher. Rarely, in middle-aged and elderly patients , bleeding into the brain tissue ( parenchymal ) due to blood pressure may also open into the subarachnoid space or ventricles and cause hydrocephalus.

Normal Pressure Hydrocephalus ( Hakeem Adams syndrome )

Although this type of hydrocephalus is usually in elderly patients, it can sometimes occur in middle-aged and young patients. The characteristic symptoms of this disease are gait disturbance (walking with short strides, balance disorder), forgetfulness (especially recent ones) and urinary incontinence. Symptoms of this disease can often be confused with dementia . It is recommended to perform a lumbar puncture (fluid removal from the waist) in order to clarify the diagnosis in patients with normal pressure hydrocephalus findings on Brain Magnetic Resonance images of patients presenting with such complaints . The diagnosis becomes clear in patients whose complaints regress after lumbar puncture , and shunt surgery can be recommended to patients.

Symptoms of hydrocephalus in adult patients

In middle-aged adults, balance disorder, urinary incontinence, signs of dementia (dementia) and in addition to these, headache, difficulty in waking up or staying awake, personality disorder, visual impairment may be seen. Elderly patients may experience gait instability, difficulty in remembering, urinary incontinence, as well as impaired communication and headache.

Diagnosis

1. Magnetic Resonance Imaging (MRI) is the gold standard. With these examinations, the own tissue of the brain can be evaluated in detail . In addition, the movements of the cerebrospinal fluid in the brain tissue between the cells and the flow and movements of this fluid in the ventricles and channels in and around the brain can also be evaluated. In addition, pathologies such as tumor causing hydrocephalus can be detected.
2. resonance imaging (MRI) methods that show the cerebrospinal fluid flow : These tests are especially used in cases that prevent the flow of cerebrospinal fluid. Although large tumors and other large pathologies that prevent fluid flow can be diagnosed with normal MRI, small tumors and sometimes congenital and acquired stenosis and obstructions in fluid flow pathways may not be visible on normal MRI . In these cases, MRI examinations showing cerebrospinal fluid flow can also be used.
3. Although Computed Tomography (CT) is an examination that shows bone tissue better, it is also frequently used in hydrocephalus. It also shows bleeding, especially in patients with new bleeding.

Treatment

  Shunt insertion: The purpose of shunting is to transfer excess fluid accumulated in the brain cavities to different cavities of the body. In this procedure, the ventricles in the head a catheter is placed, this catheter is combined with the pump, a second longer catheter is connected to the other end of the pump , this catheter is carried under the skin to the abdominal cavity and the end is placed in the abdomen. In this way, excess fluid in the brain is transferred to the abdomen . Excess fluid is absorbed from the abdomen. Connecting the catheters to the brain and abdomen just above the skull , the pump allows the cerebrospinal fluid to flow above a certain pressure in a controlled manner. In this way, the fluid accumulated in the brain is discharged to another part of the body. Usually, the abdominal cavity is used to drain this fluid. The other end of the catheter , which goes to the abdominal side, can also be connected to different parts of the body. In some cases, this fluid may also be drained into the heart through a vein in the chest cavity or neck that goes to the heart. The shunt pumps used can be of the type with constant pressure adjustment and can be changed externally after the adjustment is installed. The choice is made according to the clinical condition of the patients. Patients with shunts are followed closely. Failure of the shunt or infection may occur. Although the infection usually develops in the first 6 weeks after surgery, it can also be seen later . repetitive shunt Antibiotic shunts can be used in patients with infection .