Hydrocephalus

Outline:

I. What is hydrocephalus?

II. What causes hydrocephalus?

III. Some facts about hydrocephalus.

IV. What are the symptoms of hydrocephalus?

V. What are the treatments/teaching strategies for hydrocephalus?

VI. Resources

VII. Conclusion

What is hydrocephalus?

According to the National Institute for Neurological Disorders and Stroke (NINDS), hydrocephalus is a condition whose primary characteristic is overabundant amount of fluid in the brain. The word comes from the Greek words "hydro" (water) and "cephalus" (head). Despite the name, however, the liquid that accumulates in the brain is in fact Cerebrospinal Fluid (CSF), not water. The CSF flows through ventricles in the brain and causes them to expand, causing unsafe and damaging pressure on the brain. This is an ongoing condition that many people will have for the rest of their lives.

In a normal functioning brain the CSF passes through these ventricles and falls into wells around the brain. While in these wells the CSF bathes the surfaces of the brain and spinal cord and then is reabsorbed into the bloodstream. If a blockage or lack of absorption happens in any of these areas it can cause a buildup.

CSF has many important functions, including: cushioning the brain from harsh impacts, delivering nutrients and removing waste (much as your blood does throughout the rest of your body) and regulating the pressure caused by the varying amounts of blood volume in the brain. For these reasons it is important that when treating hydrocephalus, a healthy amount of cerebrospinal fluid remains.

Facts about Hydrocephalus

The following statistics were taken directly from the National Hydrocephalus Foundation website.

  • Hydrocephalus is one of the most common birth defects, each year one out of every 500 births results in hydrocephalus
  • Another 6,000 children annually develop hydrocephalus during the first 2 years of life
  • Brain injury occurs every 15 seconds in this country - and in some cases leads to the development of hydrocephalus
  • There are approximately 75,000 discharges a year from hospitals in the U.S. with a diagnosis of hydrocephalus
  • More than 50% of hydrocephalus cases are congenital
  • 70-90% of children born with spina bifida also develop hydrocephalus
  • CSF shunting procedures account for approximately $100 million health care spending in the United States alone - half of this amount is spent on shunt revisions
  • In the past 25+ years, death rates associated with hydrocephalus have decreased from 54% to 5%, and the occurrence of intellectual disability has decreased from 62% to 30%
  • Normal Pressure Hydrocephalus affects adults and can cause dementia, difficulty in walking and, urinary incontinence

What causes hydrocephalus?

The causes of hydrocephalus are still not well known, though the theories have been narrowed down. The University of California, Los Angeles divides hydrocephalus into two categories: congenital (present at birth) and acquired (occuring after birth).

Congenital hydrocephalus may be influenced by environmental and/or genetic factors such as Aqueductual Stenosis (the narrowing of the cerebral aqueduct which connects the third and fourth ventricles of the brain) or Spina Bifida.

Acquired hydrocephalus may be a result of intraventricular hemorrhage, meningitis, head trauma, tumor, or cysts.

What are the symptoms of hydrocephalus?

Symptoms of hydrocephalus vary with age, disease progression, and individual differences in tolerance to the condition. Infants have a higher tolerance to the disease since their skulls are softer and the sutures (the fibrous joints that connect the bones of the skull) have not yet closed. For this reason their skulls can expand to allow room for the build-up. For this reason the most visible symptom of hydrocephalus in infants in an overly large head size. Other symptoms are:

  • vomiting
  • sleeplessness
  • irritability
  • downward deviation of the eyes
  • seizures

Many children are diagnosed before birth now, thanks to the increasing quality in medical imagine.

Downward deviation of the eyes (Sunsetting)

Older children and adults will most likely have more symptoms since their skulls cannot expand to accommodate the pressure. Symptoms include:

  • headache
  • vomiting
  • nausea
  • blurred or double vision
  • problems with balance
  • poor coordination
  • gait disturbance
  • urinary incontinence
  • slowing or loss of developmental progress
  • lethargy
  • drowsiness
  • irritability

Normal Pressure Hydrocephalus (NPH) is a condition that effects mostly the elderly and the most common symptoms include problems with walking, impaired bladder control leading to urinary frequency and/or incontinence, and progressive mental impairment and dementia. It's harder to detect this type of hydrocephalus because it closely resembles other illnesses in the brain. The treatment also can be dangerous because of the sensitivity of the area that needs to be treated (the spinal cord and the brain) and risk of infection.

Treatments of Hydrocephalus

There is no cure for hydrocephalus, only treatments which can minimize its detrimental effects.

Hydrocephalus is usually treated by placing a shunt which drains the excess fluid from the brain into the abdomen where it can then be naturally absorbed into the blood again. A shunt is a flexible but durable plastic tube. A valve along the tube makes sure the fluid flows one way so pressure in the brain does not increase.

Another form of treatment, used only on a small amount of people, is cutting a small hole in the third ventricle to allow the fluid to flow back towards the reabsorption areas. In order to do this procedure tiny instruments and cameras must be used to get to the hard to each areas of the brain.

Teaching Strategies

It is not uncommon for hydrocephalus to be followed by learning disabilities. We who are educators should be highly aware of this. According to the Hydrocephalus Association, the most common learning disabilities associated with Hydrocephalus are the following:

  • Non-verbal learning disorder
  • Difficulties understanding complex and abstract concepts
  • Difficulties in retrieving stored information
  • Spatial/perceptual disorders

While learning difficulties can be detected at a young age, often they are not discovered until 3rd or 4th grade when thinking becomes more abstract and complex. Children who have hydrocephalus should have an IEP to help recognize difficult areas and come up with strategies for overcoming them.

Sometimes children are in denial about their learning difficulties or parents may be the ones not wanting to admit that their child is struggling, but the sooner the child can get help the better. Early intervention is critical.

That being said every child is different, not all children will respond to hydrocephalus the same and some may have no learning difficulties at all. Nevertheless it is good to be aware in order to be better prepared for any problems that may arise.

Strategies a teacher can use include:

  • Task analysis - breaking an activity into smaller, achievable steps.
  • Using strengths (especially verbal)
  • Allowing alternate means of expression

More information can be found in the following PDF file put together by the Hydrocephalus Association specifically for Teachers.

http://www.hydroassoc.org/docs/A_Teachers_Guide_to...

Resources

National Hydrocephalus Foundation
Website: http://www.nhfonline.org
Executive Producer - Debbi Fields
Email: debbifields@nhfonline.org
Phone: (562) 924-6666
Toll Free: (888) 857-3434

Hydrocephalus Association
Website: http://www.hydroassoc.org
Email: info@hydroassoc.org

Phone: (301) 202-3811
Toll free: (888) 598-3789

Children's Hydrocephalus Support Group
Website: http://www.hydrosupport.org
Lori Poliski/Paul Gross
Email: lpoliski@hydrosupport.org
Phone: (452) 482-0479

Conclusion

Hydrocephalus is a treatable, though incurable, malady that may cause difficulties for a child later in their life. Whether they were born with it or were struck with it later in life due to illness or injury, being aware of hydrocephalus and the difficulties it might inflict on a child's learning and their life will help us as educators better help them to lead a fulfilling life and to learn all they need to do so.

Citations

A Teacher's Guide to Hydrocephalus. (2002). Retrieved February 8, 2015, from http://www.hydroassoc.org/docs/A_Teachers_Guide_t...

Facts about Hydrocephalus | Hydrocephalus statistics | NHFOnline.org. (n.d.). Retrieved February 10, 2015, from http://nhfonline.org/facts-about-hydrocephalus.ht...

Hydrocephalus Fact Sheet. (2013, May 1). Retrieved February 6, 2015, from http://www.ninds.nih.gov/disorders/hydrocephalus/...

Hydrocephalus. (n.d.). Retrieved February 12, 2015, from http://www.chop.edu/conditions-diseases/hydroceph...

NINDS Normal Pressure Hydrocephalus Information Page. (2014, April 16). Retrieved February 6, 2015, from http://www.ninds.nih.gov/disorders/normal_pressur...

Normal Pressure Hydrocephalus (NPH). (n.d.). Retrieved February 12, 2015, from http://www.alz.org/dementia/normal-pressure-hydro...

UCLA Neurosurgery. (n.d.). Retrieved February 7, 2015, from http://neurosurgery.ucla.edu/body.cfm?id=164

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