From the Guidelines
Adult hydrocephalus symptoms typically include headaches, nausea, vomiting, gait disturbances, and visual symptoms such as diplopia, altered acuity, and Parinaud’s syndrome, which are primarily caused by obstructive hydrocephalus and increased intracranial pressure. These symptoms can develop due to the accumulation of excess cerebrospinal fluid in the brain's ventricles, leading to increased intracranial pressure and compression of brain tissue. According to the most recent consensus on management of pineal parenchymal tumors 1, patients often present with symptoms of obstructive hydrocephalus and increased intracranial pressure. Key symptoms to look out for include:
- Headache
- Nausea
- Vomiting
- Gait disturbances
- Visual symptoms, including diplopia, altered acuity, and Parinaud’s syndrome. It is essential to note that these symptoms can be similar to those of other neurological conditions, and a thorough medical evaluation is necessary for an accurate diagnosis. If diagnosed early, treatment with surgical shunting procedures can often improve symptoms, emphasizing the importance of prompt medical attention if these symptoms occur. The management of such patients should be done in consultation with neurosurgery and critical care, and when possible, patients should be transferred to a tertiary referral center for further workup and management 1.
From the Research
Symptoms of Adult Hydrocephalus
- Disorientation and pain (headaches) 2
- Cognitive and developmental changes 2
- Vision and sleep disturbances 2
- Gait abnormalities 2
- Gait ataxia, dementia, and urinary incontinence, particularly in cases of idiopathic normal pressure hydrocephalus (iNPH) 3
- Ventricular enlargement, deformation, and poor brain compliance, with varying degrees of severity 4
Clinical Characteristics
- Hydrocephalus can occur in adults at any age, with a wide range of causes, including genetic mutations and post-traumatic injury 5
- The condition can be chronic or acute, with chronic hydrocephalus in adults (CHiA) covering a spectrum of disorders 6
- CHiA disorders can be clustered into 7 distinctive clinical entities based on clinical characteristics 6
Diagnosis and Treatment
- Diagnosis of hydrocephalus in adults can be challenging, particularly in patients with severe disorders of consciousness (DOC), where typical symptoms may be concealed by limited behavioral responsiveness 4
- Surgical treatment options, such as ventriculoperitoneal shunting (VPS) and endoscopic third ventriculostomy (ETV), can be effective, but may have varying outcomes and complications 3
- Active treatment of hydrocephalus can significantly improve patients' consciousness and neurological function, even months or years after the onset of severe DOC 4