Introduction 

Hydrocephalus is a condition where cerebrospinal fluid (CSF) builds up within the brain’s ventricles, causing increased pressure and damaging brain tissue, leading to motor and cognitive difficulties. About 70% of hydrocephalus cases are congenital, affecting 1 in 500 births every year. Although the condition typically affects young children, it can develop at any age, usually due to another illness or injury. It is diagnosed with CT or MRI imaging, and treatment involves draining excess CSF from the brain. Occupational therapy can help to manage the condition by providing strategies and adaptive equipment to enhance independence and daily functioning.¹

What is cerebrospinal fluid?

Hydrocephalus is a neurological condition resulting from the accumulation of cerebrospinal fluid (CSF) in the brain's ventricles. This excess fluid enlarges the ventricles, creating harmful pressure on brain tissues, which can damage brain function. CSF is a clear fluid that circulates and cushions the brain and spine. It is normally reabsorbed into the bloodstream, but an imbalance or blockage can lead to hydrocephalus.² It also plays a vital role in removing waste products from the central nervous system, ensuring its optimal function. CSF supports muscle movement, organ function, and cognitive processes like memory.³

Symptoms of Hydrocephalus

Hydrocephalus symptoms vary by age. In infants, they include a rapid increase in head size, an unusually large head, a bulging fontanel, vomiting, feeding problems, sleepiness, irritability, downward-fixed eyes, and seizures. Older children and adults may experience headaches, vision problems, nausea, balance issues, developmental delays, poor coordination, bladder control problems, cognitive changes, and personality shifts. Older adults often show difficulties in walking, mental decline, and balance issues.²

Prevalence of Hydrocephalus

Estimating the prevalence of hydrocephalus is challenging due to the numerous causes and differences in presentation over the life span. It is estimated that 1 to 2 in every 1,000 babies are born with hydrocephalus. Causes in newborns include genetic abnormalities, developmental disorders, complications from premature birth, and infections during pregnancy. In adults, risk factors for hydrocephalus include: 

• Brain or spinal cord tumours
• entral nervous system infections 
• Trauma - such as brain injury
• troke- causing brain bleeding²

Diagnosis of Hydrocephalus

Diagnosis involves neurological exams and imaging tests such as an ultrasound scan for infants, and an MRI scan or CT scans for adults. 

Additional tests include: lumbar puncture to assess CSF pressure and fluid analysis, intracranial pressure monitoring, and fundoscopic examination to detect optic nerve swelling.²

Treatment of Hydrocephalus

Treatment options include:

• Shunt system: a tube drains excess CSF from the brain to the chest cavity or abdomen.
• Endoscopic third ventriculostomy (ETV): creates an opening in the third ventricle of the brain to divert CSF flow when there has been a blockage. It is sometimes combined with choroid plexus cauterization to reduce CSF production.
• Choroid Plexus Cauterization: burns CSF-producing tissue to decrease fluid production.

Hydrocephalus recovery

Early diagnosis of hydrocephalus leads to better outcomes, with recovery depending on the patient's age, the type of hydrocephalus, and the treatment method. Full benefits from surgery may take months, and physical, cognitive, and occupational therapy are crucial for recovery. Physical therapy can enhance gait, balance, and motor skills; cognitive therapy can improve speech, thinking skills, memory, and address learning disorders; and occupational therapy can aid in balance, coordination, and daily routine skills at home.⁴

Occupational therapy 

Occupational therapy helps people of all ages to regain independence following an injury, illnesses, cognitive or mental health issues, developmental problems, learning disabilities, or physical disabilities. The goal is to enhance their ability to perform daily tasks, improving their overall well-being and quality of life.⁵

Occupational therapists are essential in treating patients with brain injuries or neurological illnesses such as hydrocephalus. They use a holistic approach to deliver tailored, goal-oriented rehabilitation programs to clients. Therapists assess physical, cognitive, and behavioural impairments and create personalized rehabilitation plans to improve daily functioning and independence.⁵ The main goal is to help the individual and their families achieve independence and lead a normal life. 

Occupational therapy may involve: 

• Adapting daily living tasks 
• Using equipment or adaptations
• Fatigue management
• Self care techniques such as cooking, eating, getting dressed
• Improving communication skills
• Developing functional skills and improving fine motor skills
• Organisation techniques 
• Accessing education, volunteering or work

Benefits of occupational therapy include:¹ 

• Enhanced balance
• Greater independence
• Assistance in planning movements
• Improved coordination 

FAQ’s 

What is the number of people diagnosed annually with hydrocephalus?

In the UK, 1 in every 750 children has hydrocephalus.

Is it possible for hydrocephalus to be cured?

Surgical treatment can provide symptomatic relief for hydrocephalus, but there is currently no cure.

Is congenital hydrocephalus hereditary?

Congential hydrophalus may be hereditary, as it can be caused by genetic mutations, but this is still being investigated. 

Summary

Hydrocephalus is a condition characterised by the accumulation of cerebrospinal fluid in the ventricles of the brain. This can increase the pressure in the brain, degrading the brain tissue. The condition can occur in babies, children and adults. Diagnosis is based on an MRI scan or CT scan. Treatment involves surgical interventions such as the shunt system, endoscopic third ventriculostomy (ETV) or cauterization of the choroid plexus. Recovery from surgery can take months. Occupational therapy plays an essential role in recovery. Occupational therapists focus on practical improvements in everyday tasks to increase the individual’s independence and quality of life.