Focal neurological deficits may also occur, such as abducens nerve palsy and vertical gaze palsy ( Parinaud syndrome due to compression of the quadrigeminal plate, where the neural centers coordinating the conjugated vertical eye movement are located). Hakim's triad of gait instability, urinary incontinence, and dementia is a relatively typical manifestation of the distinct entity normal-pressure hydrocephalus. Elevated ICP may result in uncal or tonsillar herniation, with resulting life-threatening brain stem compression. Hearing loss is a rare but well-known sequela of procedures resulting in CSF loss. Transient SNHL has been reported after the loss of CSF with shunt surgeries. Elevated ICP of different etiologies have been linked to sensorineural hearing loss (SNHL). With increased levels of CSF, there have been cases of hearing loss due to CSF creating pressure on the auditory pathways or disrupting the communication of inner ear fluid. Symptoms of increased ICP may include headaches, vomiting, nausea, papilledema, sleepiness, or coma. By contrast, chronic dilatation (especially in the elderly population) may have a more insidious onset presenting, for instance, with Hakim's triad (Adams' triad). Acute dilatation of the ventricular system is more likely to manifest with the nonspecific signs and symptoms of increased intracranial pressure (ICP). The clinical presentation of hydrocephalus varies with chronicity. Illustration showing different effects of hydrocephalus on the brain and cranium The word hydrocephalus is from the Greek ὕδωρ, hydōr, meaning 'water' and κεφαλή, kephalē, meaning 'head'. Description of hydrocephalus by Hippocrates dates back more than 2,000 years. Normal pressure hydrocephalus is estimated to affect about 5 per 100,000 people, with rates increasing with age. Rates in the developing world may be higher. Ībout one to two per 1,000 newborns have hydrocephalus. Without treatment, death or permanent disability may occur. Outcomes are variable, but many people with shunts live normal lives. Complications from shunts may include overdrainage, underdrainage, mechanical failure, infection, or obstruction. A procedure called a third ventriculostomy is an option in some people. Hydrocephalus is typically treated by the surgical placement of a shunt system. Diagnosis is typically made by physical examination and medical imaging. The four types of hydrocephalus are communicating, noncommunicating, ex vacuo, and normal pressure. Other causes include meningitis, brain tumors, traumatic brain injury, intraventricular hemorrhage, and subarachnoid hemorrhage. Associated birth defects include neural tube defects and those that result in aqueductal stenosis. Hydrocephalus can occur due to birth defects or be acquired later in life. Other symptoms may include vomiting, sleepiness, seizures, and downward pointing of the eyes. In babies, it may be seen as a rapid increase in head size. Older people may have headaches, double vision, poor balance, urinary incontinence, personality changes, or mental impairment. This typically causes increased pressure inside the skull. Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. Neural tube defects, meningitis, brain tumors, traumatic brain injury, brain bleed during birth, intraventricular hemorrhage īased on symptoms and medical imaging Older people: Headaches, double vision, poor balance, urinary incontinence, personality changes, mental impairment Babies: rapid head growth, vomiting, sleepiness, seizures
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