Hydrocephalus (water on the brain)

Hydrocephalus is the abnormal increase in the amount of cerebrospinal fluid (CSF) within the ventricles of the brain. CSF is the clear watery fluid containing glucose , salts, enzymes and a few white cells that surrounds the brain and spinal cord providing nourishment, and also cushion from contact with the skull. The CSF flows over the brain through ventricles and channels and is drained back into the blood circulation. Anything that disrupts this continuous process may cause hydrocephalus. CSF may accumulate from over production, impaired outflow or reabsorption into circulation. Hydrocephalus may be acute, subacute or chronic occurring over days, weeks or months to years respectively. In childhood, before the sutures of the skull have fused, hydrocephalus makes the head enlarge but the unyielding nature of the adult skull just raises the pressure within the skull with resultant vomiting and drowsiness. 

 
Causes
*Idiopathic- no known cause
*Infections- Meningitis (especially bacterial)
*Congenital anomalies-spina bifida
*Head injuries
*Space occupying lesions- tumors, hematomas, abscesses etc

Signs and Symptoms
*In children, unusually big head (other conditions to be discussed later-oxycephaly, scaphocephaly, plagiocephaly, thalassemia, SCD etc may present same), irritability, poor feeding
*Bulging fontanelle 
*Drowsiness, double vision
*Setting sun sign ( retracted upper eyelid with of eye showing)
*Vomiting (usually early morning)
*Headache (usually severe in the morning )
*Cognitive impairment
*Loss of bladder control (urinary incontinence), paralysis etc 

Management
A drain may be placed to shunt the fluid into the heart (ventriculo-atrial shunt) or abdomen (ventriculo-peritoneal shunt)

Prevention
*Discuss with your physician if you think your child’s head is bigger than normal
*Follow up your physician if you have had a head injury or have been treated for meningitis for a minimum of a year.