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Sunday, 1 December 2013

Hydrocephalus - The Symptoms

Hydrocephalus, also known as "water in the brain" is defined as complex and multifactorial neurological disorders of accumulation of cerebrospinal fluid (CSF) in the cavity of brain of that can lead to intracranial pressure inside the side, resulting of brain trauma, stroke, infection, tumor, etc.
Symptoms
A.  In infancy
1. Increase in head circumference or an unusually large head size
Fluid accumulated will result in Increase in head circumference or an unusually large head size in infant regardless to the types of hydrocephalus due to bulge of the fontanelle (soft spot), Dr. Bhasker B and the research team in the reports a new finding in two siblings with primary hypomagnesaemia as a result of renal magnesium wasting, namely, rapidly increasing head size. External hydrocephalus and brain shrinkage in primary hypomagnesaemia seen on computed tomography of the brain with reversibility after magnesium treatment has not been reported previously(16).

2. Rapid eye movement sleep
In the monitor of Intracranial pressure (ICP) for 24 h in 30 hydrocephalic patients (21 infants, 9 children) showed that during sleep related to a period of rapid eye movement (REM) fairly regular steep-rising waves of raised ICP recurred every 50-75 min, decreasing slowly to previous levels in 25-40 min(17).

3. Sleepiness, Irritability, Sunsetting of the eyes, Seizures are most common symptoms in infant(18)

4. Other symptoms
Dr. Kirkpatrick M and scientists at the Royal Hospital for Sick Children, in the study of Symptoms and signs of progressive hydrocephalus, showed that in the clinical features of 107 cases of children with hydrocephalus and measured raised intraventricular pressure were analysed retrospectively. Fifty one children had recently been diagnosed as having hydrocephalus, and the remainder had had shunts injected to direct the cerebrospinal fluid. The most common symptoms in the group were vomiting, behavioural changes, drowsiness, and headaches. The most common clinical signs were inappropriately increasing occipitofrontal head circumferences, tense anterior fontanelles, splayed sutures, and distension of the scalp veins. Half the infantile cases of hydrocephalus were without symptoms, and a quarter of the cases with cerebrospinal fluid shunts and measured raised intraventricular pressure were without signs. There were no fewer than 33 different clinical signs including several unusual ones, such as macular rash and sweating. We believe that the presentation of hydrocephalus with raised intraventricular pressure is sufficiently variable, unusual, or even absent to justify the direct measurement of intracranial pressure(19).


8. Etc.

B.  Children and adults
Beside some symptoms mentioned in the infant section, Children and adults with the disease may also be experience other symptoms because of the head can no longer expand to accommodated to the accumulation of the fluid
1. The most common symptoms in the group were vomiting, behavioural changes, drowsiness, and headaches. The most common clinical signs were inappropriately increasing occipitofrontal head circumferences, tense anterior fontanelles, splayed sutures, and distension of the scalp veins(19).

2. Diplopia, headaches, and papilledema
Hydrocephalus can also cause symptoms of diplopia, headaches, and papilledema, There is a report of a 48-year-old woman was admitted to the hospital because of diplopia, headaches, and papilledema. Imaging revealed cysts in the fourth ventricle and spinal canal(20)


3. Headache, hearing difficulty and blurred vision
Headache and blurred vision are also associated with symptoms of hydrocephalus. There is a report of a
patient of 25-year-old female, admitted to the department of otorhinolaryngology with complaints of hearing difficulty, headache and blurred vision(21).

4. Other symptoms
Dr. Kubo Y and research team at the Osaka University Graduate School of Medicine, in the study of Validation of grading scale for evaluating symptoms of idiopathic normal-pressure hydrocephalus, showed that the interrater reliability of this scale was high. The iNPHGS cognitive domain score significantly correlated with the cognitive test scores, including the Mini-Mental State Examination (MMSE), the gait domain score with the Up and Go Test and Gait Status Scale scores, and the urinary domain score with the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. The MMSE, Gait Status Scale and ICIQ-SF scores significantly improved in patients whose iNPHGS scores improved after CSF tapping but not in those whose iNPHGS scores did not improve after CSF tapping. Fourteen of the 38 patients received shunt operations. In these 14 patients, changes in the iNPHGS cognitive and urinary domains after CSF tapping were significantly associated with the changes after the shunt operation(22). Other found that the most frequently observed neuropsychiatric symptom in the iNPH patients was apathy followed by anxiety and aggression. No symptom was more prevalent or more severe in iNPH than in AD. The severity of cognitive impairment was correlated with both aberrant motor activity and apathy(23).

5. Etc. 


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Sources   
(16) http://www.ncbi.nlm.nih.gov/pubmed/10569968
(17) http://www.ncbi.nlm.nih.gov/pubmed/183936
(18) http://pediatrics.about.com/cs/conditions/a/hydrocephalus_2.htm
(19) http://www.ncbi.nlm.nih.gov/pubmed/2923462
(20) http://www.ncbi.nlm.nih.gov/pubmed/22591299
(21) http://www.ncbi.nlm.nih.gov/pubmed/2046855
(22) http://www.ncbi.nlm.nih.gov/pubmed/18025828
(23) http://www.ncbi.nlm.nih.gov/pubmed/19996513