Hydrocephalus denotes enlargement of the ventricular system due to excessive cerebrospinal fluid (CSF) accumulation. In the setting of communicating hydrocephalus, the resorption of CSF is impaired, causing various neurologic symptoms, macrocephaly, and dementia, depending on the age of onset and severity. Ultrasonography, computed tomography or magnetic resonance imaging are used in different patient populations. Lumbar drainage or insertion of shunts are the main forms of treatment.
Lethargy, vomiting, irritability and a prominent, bulging fontanelle are main signs of hydrocephalus in infants, whereas headaches and reduced vision may be reported at a later age  . Papilledema, both learning and cognitive disorders, as well as the appearance of precocious puberty, may be seen  , together with gait disturbance, urinary incontinence, dementia and a range of other neurological deficits .
The diagnosis of hydrocephalus can be made during regular prenatal assessment with fetal ultrasonography , while CT or MRI can confirm ventricular enlargement in infants and older age groups . An increased head circumference or a bulging fontanelle are definite signs of increased intracranial pressure, which signifies the need for a detailed physical examination at birth and during subsequent visits, especially if infants develop symptoms suggestive of hydrocephalus .
The goal of treatment is to stabilize the levels of CSF in the ventricular system and relieve the pressure to the brain parenchyma, which may be performed by lumbar drainage and placement of ventricular shunts in severe cases  . Endoscopic third ventriculostomy (ETV) is considered as an effective therapeutic procedure , but complications such as infection and malfunction may be life-threatening, further strengthening the role of an early diagnosis .
The importance of an early diagnosis is emphasized across numerous reports   , as the condition may cause long-term consequences that can severely impair the quality of life.
Intraventricular hemorrhage (IVH) as a result of prematurity is the most notable cause of communicating hydrocephalus  , but numerous disorders can induce abnormal accumulation of CSF   :
The prevalence rates of hydrocephalus as a congenital malformation is estimated to occur in about 4.65 per 10,000 births , whereas rates among infants rise to 32 per 10,000 births . Use of antidepressants during the first trimester, multiple gestations, and maternal diabetes were established as risk factors for congenital hydrocephalus  .
Cerebrospinal fluid (CSF) is produced at several sites along the central nervous system - the choroid plexus, brain parenchyma, spinal cord and ependymal lining of the ventricles . The CSF has a unidirectional flow from lateral ventricles into the third and fourth ventricles through the foramen of Monro and the Sylvian aqueduct, respectively, followed by entrance into the subarachnoid space, where it is absorbed into the jugular venous system . In the communicating hydrocephalus, there is a lack of reabsorption of CSF. In non-communicating hydrocephalus open link, there is an obstruction to the CSF-flow, that is not observed with this type. The end-result is the accumulation of CSF within the ventricular system and subsequent dilation of the ventricles, leading to increased pressure in the brain parenchyma, loss of brain cells and the appearance of numerous neurological deficits that can cause the stroke or even death .
Avoidance of drugs that were proposed to increase the risk (metronidazole, misoprostol, antidepressants) and a thorough prenatal assessment in order to identify hydrocephalus early on may be effective preventive strategies.
Hydrocephalus is a condition characterized by abnormal concentrations of cerebrospinal fluid due to numerous congenital, neoplastic, or infectious diseases. It causes enlargement of the ventricular system and two main types exist - non-communicating (also known as obstructive), in which occlusion causes increased pressure; and communicating, characterized by impaired resorption or flow of CSF . Recent studies have proposed a different classification, however, dividing hydrocephalus into acute (or obstructive) and chronic that is further divided into communicating and chronic obstructive . Meningeal infection is considered to be the most important event in the pathogenesis of communicating hydrocephalus . The clinical presentation varies across different age groups, ranging from macrocephaly and a bulging fontanelle in infants, induction of precocious puberty in girls, to numerous neurologic disorders in children and adults, such as gait disturbances, learning and cognitive deficits, but also dementia  . The diagnosis can be made by ultrasonography in neonates and infants, whereas computed tomography (CT) or magnetic resonance imaging (MRI) are recommended for older age groups . Lumbar drainage and ventricular shunting are currently the mainstays of therapy  .
Hydrocephalus is a clinical term that describes an increased amount of cerebrospinal fluid in the brain. Normally, the cerebrospinal fluid serves as a "cushion" for the brain and as a transporter of various nutrients across the central nervous system and hydrocephalus occurs either when its flow is obstructed or when its absorption is impaired, which is the hallmark of communicating hydrocephalus. The most common cause of communicating hydrocephalus is inflammation of the meninges (for ex. in meningitis or hemorrhage into the ventricular system). The condition is primarily encountered in infants and children and headaches, irritability, lethargy and vomiting are principal symptoms. Physical examination can reveal an enlarged head (macrocephaly) and a bulging, prominent fontanelle. If the diagnosis is not made early on, the increased pressure in the brain can lead to brain cell death and consequences such as learning disorders and various neurological deficits. For this reason, it is imperative to conduct thorough check-ups during prenatal visits, as physicians can detect hydrocephalus with ultrasonography before birth. In older children, computed tomography or magnetic resonance imaging are used for confirmation. In order to treat hydrocephalus, it is necessary to remove excess cerebrospinal fluid, either through drainage from the lumbar spine or by placement of a shunt into the skull and the ventricles.