Hydrocephalus

Hydrocephalus (Gr. ὕδωρ, water, and κεφαλὴ, head), a term applied to disease of the brain which is attended with excessive effusion of fluid into its cavities. It exists in two forms—acute and chronic hydrocephalus. Acute hydrocephalus is another name for tuberculous meningitis (see Meningitis).

Chronic hydrocephalus, or “water on the brain,” consists in an effusion of fluid into the lateral ventricles of the brain. It is not preceded by tuberculous deposit or acute inflammation, but depends upon congenital malformation or upon chronic inflammatory changes affecting the membranes. When the disease is congenital, its presence in the foetus is apt to be a source of difficulty in parturition. It is however more commonly developed in the first six months of life; but it occasionally arises in older children, or even in adults. The chief symptom is the gradual increase in size of the upper part of the head out of all proportion to the face or the rest of the body. Occurring at an age when as yet the bones of the skull have not become welded together, the enlargement may go on to an enormous extent, the Spaces between the bones becoming more and more expanded. In a well-marked case the deformity is very striking; the upper part of the forehead projects abnormally, and the orbital plates of the frontal bone being inclined forwards give a downward tilt to the eyes, which have also peculiar rolling movements. The face is small, and this, with the enlarged head, gives a remarkable aged expression to the child. The body is ill-nourished, the bones are thin, the hair is scanty and fine and the teeth carious or absent.

The average circumference of the adult head is 22 in., and in the normal child it is of course much less. In chronic hydrocephalus the head of an infant three months old has measured 29 in.; and in the case of the man Cardinal, who died in Guy’s Hospital, the head measured 33 in. In such cases the head cannot be supported by the neck, and the patient has to keep mostly in the recumbent posture. The expansibility of the skull prevents destructive pressure on the brain, yet this organ is materially affected by the presence of the fluid. The cerebral ventricles are distended, and the convolutions are flattened. Occasionally the fluid escapes into the cavity of the cranium, which it fills, pressing down the brain to the base of the skull. As a consequence, the functions of the brain are interfered with, and the mental condition is impaired. The child is dull, listless and irritable, and sometimes imbecile. The special senses become affected as the disease advances; sight is often lost, as is also hearing. Hydrocephalic children generally sink in a few years; nevertheless there have been instances of persons with this disease living to old age. There are, of course, grades of the affection, and children may present many of the symptoms of it in a slight degree, and yet recover, the head ceasing to expand, and becoming in due course firmly ossified.

Various methods of treatment have been employed, but the results are unsatisfactory. Compression of the head by bandages, and the administration of mercury with the view of promoting absorption of the fluid, are now little resorted to. Tapping the fluid from time to time through one of the spaces between the bones, drawing off a little, and thereafter employing gentle pressure, has been tried, but rarely with benefit. Attempts have also been made to establish a permanent drainage between the interior of the lateral ventricle and the sub-dural space, and between the lumbar region of the spine and the abdomen, but without satisfactory results. On the whole, the plan of treatment which aims at maintaining the patient’s nutrition by appropriate food and tonics is the most rational and successful.

(E. O.*)

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Fig. 1.—Hydrocharis Morsusranae—Frog-bit—male plant.  
  
1, Female flower.

2, Stamens, enlarged.

3, Barren pistil of male flower, enlarged.

4, Pistil of female flower.

5, Fruit.

6, Fruit cut transversely.

7, Seed.

8, 9, Floral diagrams of male and female flowers respectively.

s, Rudimentary stamens.