Hydrocephalus in Adults
While hydrocephalus is typically a disease that strikes children, there are several forms that can affect adults.
The most common forms of adult hydrocephalus are obstructive hydrocephalus, normal pressure hydrocephalus, and pseudotumor cerebri (idiopathic intracranial hypertension). The evaluation and treatment of these conditions is often quite different.
In adult onset of obstructive hydrocephalus, there is usually a mechanical blockage of the spinal fluid flow including tumors, webbings, Chiari malformation or prior hemorrhage. The usual treatment involves either endoscopic third ventriculostomy or shunting. If an MRI or CAT scan shows hydrocephalus and the patient is asymptomatic, immediate evaluation is appropriate.
The condition of normal pressure hydrocephalus (NPH) is different than many forms of hydrocephalus. This disease typically is seen in older patients. The three classic symptoms are gait difficulties, memory difficulties, and difficulty controlling one’s bladder. These symptoms can also be seen in many forms of dementia, so careful evaluation is needed in order to decide whether a particular patient would benefit from shunting, which is the only treatment for NPH.
At UNC, we use a team that includes neurologists, neurosurgeons, physical therapists and speech therapists to perform a lumbar drain trial in patients being considered for shunting. The patients are admitted to the hospital for testing of their gait and cognitive function. A lumbar spinal drain is then placed and several days of spinal drainage is performed. If patients have significant improvement, as judged by their physical therapy and cognitive testing by their physician’s and family’s evaluations, a ventriculoperitoneal shunt is often placed. If the patients do not benefit from the lumbar drain, then it is presumed that the permanent shunting procedure would not benefit the patient and other treatments are explored.
Pseudotumor cerebri is a third and distinct form of adult hydrocephalus that involves high brain pressures without dilatation of the brain spaces. It is frequently seen in younger women with primary symptoms being headaches and visual difficulties. In severe cases, swelling in the back of the eyes, termed papilledema, can be seen by a skilled ophthalmologist. Initial treatment is usually medicine to reduce spinal fluid production, but if this is unsuccessful, shunting procedures can be necessary to protect the patient’s vision. At UNC, we have traditionally performed an image-guided, stereotactically-placed ventriculoperitoneal shunt for treatment of this condition primarily in patients for whom vision loss or impending vision loss is the primary issue.
UNC Neurosurgery has much expertise in hydrocephalus in both adults and children, and we have a strong interest in helping patients who are suffering from it.