Head of water in the baby

introduction

Under a head of water (Hydrocephalus) in the baby one understands an increased accumulation of fluid in the head. Every person's brain is surrounded by cerebrospinal fluid. This cerebral water is subject to a closed system in which it is both formed and absorbed.

In the brain there are certain cavities for the cerebral water, the so-called ventricles. If there is an excessive accumulation of brain water in the ventricles, this leads to an enlargement of the cavities and thus to an enlarged head.

What causes a water head in the baby?

A head of water in a baby can have various causes. In the closed system for the brain water that surrounds the brain and spinal cord, both brain water is produced and reabsorbed. If one of these two processes takes over, there is excessive accumulation in the head and thus an increase in head circumference.

Often the cause is a drainage or resorption disorder. Various diseases such as inflammation or bleeding can be responsible for this. However, there can also be a tumor at the resorption sites, which prevents the cerebral fluid from draining. A rare cause is the so-called Arnold-Chiari malformation, in which the circulation of the cerebral water is impaired.

In some cases an excessive production of the cerebral water is also the cause of a water head. A certain brain structure, the choroid plexus in the brain, is responsible for its production. If this is inflamed or changed by a tumor, overproduction of brain water can occur.

Accompanying symptoms of the water head

As a rule, a head of water in a baby is very easy to spot. The head can be significantly enlarged and assume a balloon-like shape. The fontanel, i.e. the point on the head at which the baby's skull bones only grow together later, is often stretched or even bulging.

The sunset phenomenon is also a very typical sign. Here part of the cornea of ​​the eye disappears under the lower eyelid, the baby looks downwards in a very pronounced way. This makes the iris look like a setting sun, as a clear white stripe can be seen above it.

Furthermore, so-called intracranial pressure signs can occur. These are typical signs that can arise when the pressure of the brain water increases on the brain. These include increased tiredness, recurring drowsiness, and nausea and vomiting that occurs without prior ingestion of food. This is known as vomiting on an empty stomach.

Further information on this topic can be found at: Symptoms of a water head

Shapes of the child's water head

A water head is caused by a disproportion between CSF formation and CSF outflow (see also: Liquor). As a result, either production can be increased or the outflow reduced, so that ultimately the amount of CSF increases inappropriately and more space is required in the ventricular system. This lack of space is counteracted by expanding the ventricles so that a water head is created. This hydrocephalus is particularly common in babies.

According to the formation, a distinction is made between the following water head shapes:

• Hydrocephalus occlusus = disturbance of the liquor outflow, increased intracranial pressure
• Hydrocephalus malresorptivus = disruption of liquor absorption (absorption), increased intracranial pressure
• Hydrocephalus hypersecretorius = increased liquor formation, increased intracranial pressure
• Hydrocephalus e vacuo = enlargement of the ventricles due to a decrease in brain mass (brain atrophy) with normal intracranial pressure
• Idiopathic normal pressure hydrocephalus = unclear cause of the ventricular dilation with almost normal CSF pressure

Read our article on this: Cerebral ventricle

Hydrocephalus occlusus

Hydrocephalus occlusus usually results from a blockage of the drainage channels, for example due to cancerous ulcers, inflammatory changes or bleeding in narrow areas of the connecting paths of the internal liquor system with subsequent obstruction so that the drainage of the liquor is obstructed. Such bottlenecks can be the aqueduct or the drainage routes (Foraminae Luschkae, Foramen Magendii; foramen = Hole) of the fourth ventricle.

Hydrocephalus malresorptivus

Hydrocephalus malresorptivus is caused by a resorption disorder as a result of adhesions in the area of ​​the subarachnoid space or its enlargements (Cisterns), whereby the way of the liquor into the venous system is blocked. Such adhesions can occur after bleeding in the subarachnoid space (Subarachnoid hemorrhage), purulent meningitis (purulent meningitis) or after head injuries (cranial brain trauma).

Other forms of the water head in babies

Increased liquor formation, as it is characteristic of hydrocephalus hypersecretorius, occurs, for example, through inflammation or through a new formation of the liquor-producing plexus choroidus (Plexus papilloma).

Hydrocepahlus e vacuo occurs either through a decrease in brain matter (Brain atrophy), by a brain inflammation in early childhood (encephalitis) or by abscesses (inflammatory, purulent tissue melting). In this case, the intracranial pressure is not increased.

Normal pressure hydrocephalus is characterized by only minimally increased intracranial pressure. The cause of this water head shape has not yet been fully clarified.

Classification of the water head in the baby according to location

Furthermore, there is a breakdown of the clinical picture "water head / hydrocephalus" according to localization. There are three different forms:

• Hydrocepahlus internus = enlargement of the ventricles or inner liquor spaces
• Hydrocepahlus externus = enlargement of the external liquor spaces
• Hydrocephalus communicans = expansion of the inner and outer liquor spaces, existing connection between the two spaces

Acquired or congenital water head?

Furthermore, the water head can be classified according to the time of origin, because a water head in a baby can be both congenital and acquired.

The congenital, early childhood forms arise through narrowing or obstruction of the natural connection or drainage pathways, through masses in the brain, through malformations in the area of ​​the spine, the spinal cord or the brain or through prenatal infections with, for example, toxoplasms (toxoplasmosis) or cytomegaloviruses (CMV).

An example of such a narrowing is the aqueduct stenosis, in which the connecting path between III. and IV. ventricle, the aqueduct (Aqueductus cerebri), is not completely pervious, so that the liquor cannot circulate unhindered.

With regard to the relocation of connections between the internal liquor spaces, there are atresia of the ventricular drainage pathways. This is understood to mean the lack of opening of these paths, whereby the IVth ventricle is preferably affected. As a result, there is also a CSF outflow disorder.

Malformations that cause a water head in babies are the Arnold-Chiari malformation, the Dandy-Walker malformation or the cranium bifidum.

In contrast to the water head in babies, an acquired water head can arise due to ventricular bleeding and inflammation or adhesions of the brain and meninges. Furthermore, cancer can cause a water head, for example a plexus papilloma, which is a benign neoplasm of the cerebrospinal fluid-producing choroid plexus. As a result of this papilloma, the amount of CSF formation increases.

Diagnosing a water head in the baby

In order to diagnose a head of water in a baby as such, imaging methods are best suited to depict the brain and its surroundings. An ultrasound is often done as it is the least stressful for the baby. Alternatively, a computed tomography or a nuclear spin can also be initiated. However, the risk of radiation exposure for the baby must be weighed. The CT and the MRT are mainly used as diagnostic tools in slightly older children.

What do you see in the ultrasound?

An ultrasound can easily be performed on the baby through the fontanel on the head. This is a place where the skull bones only grow together completely after a few months. The doctor gets a good look at the brain and the cavities filled with nerve water. Here an enlargement of these cavities can be observed in a water head. Depending on the development, the cause of the excessive accumulation of cerebral fluid can also be assessed.

When can you diagnose a water head?

A head of water in a baby can usually be diagnosed early. Nowadays, an ultrasound is already done during pregnancy during a preventive examination, in which, among other things, a head of water should be excluded. If the water head is already detected, it can be treated quickly.

Read more on this topic at: Ultrasound in pregnancy

However, it also happens that the baby's head of water only becomes visible after birth. If there is any suspicion, a doctor should be consulted as soon as possible.

Is there therapy for the water head in babies?

The goal of treating a baby's head of water is to reduce the cerebral water and thereby avoid excessive pressure on the child's brain. The latter can lead to long-term brain damage if treatment is missing or too late.

Therefore, drug therapy unfortunately only helps for a short time, as there are as yet no drugs that can eliminate the cause of the water head. For short-term treatment, so-called diuretics, such as Lasix®, can be given to reduce the production of cerebrospinal fluid.

Read more on this topic at: Diuretics

In the long term, however, a method must be chosen that relieves the strain on the brain. Therefore, in most cases, a shunt is the best option. This is a type of drainage that drains off part of the cerebral water and thus can reduce the pressure on the brain.

Further information on this topic can be found at: Therapy of the water head

Shunt against the water head in the baby

The insertion of a shunt is the most common therapeutic measure performed on babies with a water head today. A draining connection of the brain water from the brain is surgically placed in the abdominal cavity. To do this, a small hole is drilled into the baby's skull and a thin tube, usually made of silicone, is pushed into one of the cavities with cerebrospinal fluid. This tube is placed under the skin along its entire length and into the baby's abdominal cavity. Depending on the hair growth, this tube is no longer clearly recognizable later.

This means that adjustable and programmable valves can be used to drain the cerebral water, which will restore a sufficient balance of the pressure conditions. Most of the valves that are responsible for adjusting the shunt are gravity assisted. This means that the amount of cerebrospinal fluid that is drained off is regulated regardless of whether the baby is lying down or sitting.

Is a cure for the water head in the baby possible?

Unfortunately, the water head in babies is still not curable today. However, therapy with a shunt can reduce symptoms and possible consequences relatively well and lead a normal life with it.

Life expectancy at the water head in the baby

Unfortunately, a general statement about the life expectancy of a baby with a water head cannot be made. The prognosis and the course of the disease are very much dependent on the cause, the severity and the time of diagnosis of the water head.

It is crucial that the therapy is adequate and timely. In many cases, the placement of a shunt allows the baby to develop relatively uncomplicated. The drainage of the brain water prevents damage from being caused by permanent increased pressure on the brain. However, it can also happen that at the time of diagnosis, parts of the brain have already been damaged in the long term by the increased pressure. The symptoms depend on the location of the brain damage and can vary in severity.

Since the therapy is quite good nowadays, a life with a head of water for a baby can usually be led relatively normally and hardly any babies die from the consequences.

What are the long-term consequences of a water head?

Long-term consequences mainly depend on which brain structures are affected by the hydrocephalus. The increased amount of water leads to overpressure in the skull, which has a negative effect on the brain development of babies and can even lead to a decrease in brain mass, so that various brain areas are poorly developed. This generally leads to developmental delays and intellectual disability.

In particular, the baby's ability to learn is often affected, so that motor skills such as

• rotate,
• crawl,
• sit,
• to run

can be learned late or not at all. Language development can also be delayed. Hydrocephalus can also affect babies' social behavior and learning.

For this reason, early diagnosis and therapy are crucial so that there are as few consequential damages as possible.

Head of water in babies with spina bifida

Spina bifida is a malformation caused by a developmental disorder in the area of ​​the spine. This leads to a protrusion in the affected area of ​​the spine. It is mostly found in the lumbar vertebrae. The spina bifida must be treated surgically.

Around 80% of all babies with spina bifida also have a water head. Often these malformations go hand in hand.

Read more on this topic at: Spina bifida