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Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. SDOH can be grouped into 5 domains: Social determinants of health (SDOH) have a major impact on people’s health,
well-being, and quality of life. Examples of SDOH include: SDOH also contribute to wide health disparities and inequities. For example, people who don't have access to grocery stores with healthy foods are less likely to have good nutrition. That raises their risk of health conditions like heart disease, diabetes, and obesity — and even lowers life expectancy relative to people who do have access to healthy foods. Just promoting healthy choices won't eliminate these and other health
disparities. Instead, public health organizations and their partners in sectors like education, transportation, and housing need to take action to improve the conditions in people's environments. That's why Healthy People 2030 has an increased and overarching focus on SDOH. One of Healthy People 2030’s 5 overarching goals is specifically related to SDOH: “Create social, physical, and economic environments that promote attaining the full potential for health and
well-being for all.” In line with this goal, Healthy People 2030 features many objectives related to SDOH. These objectives highlight the importance of "upstream" factors — usually unrelated to health care delivery — in improving health and reducing health disparities. More than a dozen workgroups made up of subject matter experts with different backgrounds and areas of expertise developed these objectives. One of these groups, the
Social Determinants of Health Workgroup, focuses solely on SDOH. Social determinants of health affect nearly everyone in one way or another. Our literature summaries provide a snapshot of the latest research related to specific SDOH. Read SDOH literature summaries Across the United States, people and organizations at the local, state, territorial, tribal, and national level are working hard to improve health and reduce health disparities by addressing SDOH. Check out what our partners are doingWhat are social determinants of health?
How Does Healthy People 2030 Address SDOH?
Explore Research Related to SDOH
Learn About Other Efforts to Address SDOH
Hydrocephalus is an abnormal buildup of fluid in the ventricles (cavities) deep within the brain. This excess fluid causes the ventricles to widen, putting pressure on the brain’s tissues. Cerebrospinal fluid (CSF) is the clear, colorless fluid that protects and cushions the brain and spine. Normally, cerebrospinal fluid flows
through the ventricles and bathes the brain and spinal cord before being reabsorbed into the bloodstream. The body typically produces enough CSF each day and absorbs the same amount. However, when the normal flow or absorption of CSF is blocked it can result in a buildup of CSF. The pressure from too much CSF can keep the brain from functioning properly and cause brain damage and even death. Fortunately, there are treatment options that can restore normal levels of CSF.
Though treatment is often helpful, it may take multiple surgeries to treat hydrocephalus. (Hydrocephalus is the most common reason for brain surgery in young children.) With treatment many people lead normal and productive lives. top Hydrocephalus can affect anyone at any age but is most common in infants and older
adults. Some of these cases can be associated with abnormalities in the brain and spinal cord during pregnancy. Communicating hydrocephalus occurs when the flow of CSF is blocked after it exits the ventricles. This form is called communicating because the CSF can still flow between the ventricles, the passages between which remain open.
Reduced flow and absorption of CSF into specialized blood vessels called arachnoid villi can also result in a buildup of CSF in the ventricles and communicating hydrocephalus. Two additional types of hydrocephalus include: top The number of people who develop hydrocephalus or who are currently living with it is difficult to establish since the condition occurs in children and adults, and can develop later in life. A 2008 data review by the University of Utah found that, in 2003, hydrocephalus accounted for 0.6 percent of all pediatric hospital admissions in the United
States. Some estimates report one to two of every 1,000 babies are born with hydrocephalus. top Hydrocephalus may be present at birth (congenital) or may develop over time as a result of injury or disease (acquired). Except for hydrocephalus secondary to physical obstruction of CSF passages within the brain or skull by blood or tumor, the exact
causes of hydrocephalus are still not well understood. Congenital hydrocephalus Acquired hydrocephalus top The symptoms of hydrocephalus can vary significantly from person to person and mostly depend on age. Conditions other than hydrocephalus can cause similar symptoms so it is important to see a doctor to receive proper diagnosis and treatment. Older children, young adults, and middle-aged adults Older adults What is hydrocephalus?
What are the different types of hydrocephalus?
The two major types of hydrocephalus are called communicating hydrocephalus and non-communicating hydrocephalus.Who gets this disorder?
What causes hydrocephalus?
Babies may be born with hydrocephalus or develop the condition shortly after delivery. In these cases, hydrocephalus may be caused by:
Certain factors can increase the risk of developing hydrocephalus at any age, including:What are the symptoms?
Infants
Signs and symptoms of hydrocephalus in infants
include:
Symptoms in older
children and adults may include:
Symptoms in older adults may include:
- problems walking, often described as feet feeling "stuck"
- progressive mental impairment and dementia
- general slowing of movements
- loss of bladder control and/or frequent urination
- poor coordination and balance.
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How is hydrocephalus diagnosed?
Hydrocephalus is diagnosed through a clinical neurological exam and by using brain imaging techniques and other tests based on
- age
- symptoms
- known or suspected abnormalities in the brain or spinal cord.
Neurological exam
The neurological exam may involve tests to determine:
- muscle strength and reflexes
- coordination and balance
- vision, eye movement, and hearing
- mental functioning and mood.
Brain imaging and other tests
Tests to accurately diagnose hydrocephalus and rule out other conditions may include:
- Ultrasound is often the first test a doctor uses to diagnose infants because it is relatively simple and low risk. When used during routine prenatal exams, ultrasound may also detect hydrocephalus in unborn babies.
- Magnetic resonance imaging (MRI) can determine if the ventricles have enlarged, assess the CSF flow, and provide information about the brain tissue surrounding the ventricles. MRI is usually the initial test used to diagnose adults.
- Computed tomography (CT) can show doctors if the ventricles are enlarged or if there is an obstruction.
- Spinal tap (lumbar puncture) allows doctors to estimate CSF pressure and analyze the fluid by inserting a needle in the lower back and removing and testing some of the fluid.
- Intracranial pressure monitoring (ICP) uses a small pressure monitor inserted into the brain or ventricles to measure the pressure and detect the amount of swelling that may have occurred in the brain. If the pressure is too high, a doctor may drain the CSF to maintain the flow of oxygenated blood to the brain.
- Fundoscopic examination uses a special deviceto view the optic nerve at the back of the eye. It can show evidence of swelling that suggests elevated intracranial pressure, which can be a result of hydrocephalus.
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What is the current treatment?
Surgical treatments
Hydrocephalus is treated with one of two surgical options:
- A shunt (tube) is surgically inserted into the brain and connected to a flexible tube placed under the skin to drain the excess fluid into either the chest cavity or the abdomen so it can be absorbed by the body.
- Endoscopic Third Ventriculostomy (ETV) improves the flow of CSF out of the brain. A tiny hole is made at the bottom of the third ventricle and the CSF is diverted there to relieve pressure. Sometimes this is done in conjunction with choroid plexus cauterization to try and decrease the production of CSF. Choroid plexus cauterization uses electric current to burn the CSF-producing tissue (i.e., the choroid plexus) in the lateral ventricles in the brain, so it produces less CSF.
Shunt systems generally function well but they can fail to properly drain the CSF due to mechanical failure or infection. When this happens the CSF once again begins to build up in the brain and earlier symptoms may recur. To reduce the
buildup of CSF, the clogged shunt system is replaced to restore drainage of CSF.
Shunts require monitoring and regular medical checkups. Multiple surgeries may be needed to repair or replace a shunt throughout a person’s lifetime. Seek medical help immediately if symptoms develop that suggest the shunt system is not working properly.
Signs and symptoms of shunt malfunction may include:
- headache
- double vision or sensitivity to light
- nausea or vomiting
- soreness of the neck or shoulder muscles
- seizures
- redness or tenderness along the shunt tract
- low-grade fever
- sleepiness or exhaustion
- reoccurrence of hydrocephalus symptoms.
Other treatments
Many people diagnosed with hydrocephalus benefit from rehabilitation therapies and educational interventions. Treatment by an interdisciplinary team of medical professionals, rehabilitation
specialists, and educational experts is critical to a positive outcome.
Supportive therapies for children may include:
- occupational and developmental therapists who can help children learn life skills and develop social behaviors
- special education teachers who can help tackle learning disabilities
- mental health providers or social workers who can provide emotional support and help families find services.
Adults may also require similar support, including social workers, occupational therapists, and specialists in dementia care.
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What is the prognosis?
If left untreated, hydrocephalus can be fatal. Early diagnosis and successful treatment improve the chance for a good recovery.
With the benefits of surgery, rehabilitative therapies, and educational interventions, many people with hydrocephalus live relatively normal lives.
The symptoms of NPH usually get worse over time if the condition is not treated, although some people may experience temporary improvements.
While the success of treatment with shunts varies from person to person, some people recover almost completely after treatment and have a good quality of life.
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What research is being done?
The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world. NINDS conducts research and clinical studies to find better ways to prevent, treat, and ultimately cure disorders such as hydrocephalus.
The NINDS helps support the Hydrocephalus Clinical Research Network (HCRN), a collaboration of pediatric neurosurgery centers working together to improve the lives of children with hydrocephalus. The HCRN centers pool their hydrocephalus patient populations to more rapidly study the potential for improved treatments. The HCRN conducts multiple, simultaneous studies at its centers and maintains a substantial registry of patients and procedures.
Cellular mechanisms
Hydrocephalus is a relatively common developmental abnormality, but its underlying mechanisms are not well
understood. NINDS supports a wide range of studies that explore the complex mechanisms of normal and abnormal brain development.
For example, NINDS-funded researchers are trying to find gene mutations associated with congenital hydrocephalus. NINDS also supports research exploring how hydrocephalus affects brain nerve networks and brain function.
The early stages of brain development play an important but understudied role in the development of hydrocephalus. NINDS-funded researchers are investigating how signals in the amniotic fluid and early CSF instruct neural stem cell behavior during the pivotal early stages of brain development. This research will help scientists better understand and diagnose disorders like congenital hydrocephalus.
Other NINDS-funded researchers are examining the cellular mechanisms involved in hydrocephalus in order to help identify hydrocephalus risk factors. The results will potentially improve diagnosis, genetic risk assessment, and treatment.
Diagnosis and
treatment
Normal Pressure Hydrocephalus may account for more than 5 percent of all cases of dementia. Unlike most other causes of dementia, NPH can sometimes be reversed with treatment. However, not all surgeries are successful, and researchers do not know why some people respond to treatment and others do not. NINDS-funded researchers are developing new imaging methods to help physicians determine whether shunt surgery is likely to improve the
cognitive and motor difficulties that often accompany NPH.
Shunts are the standard treatment of hydrocephalus, but shunts can malfunction, and repeated surgery may be needed. The rate of malfunction of shunts in children is estimated to be 40 percent in the first year after placement, and 10 percent per year after that. Current methods for diagnosing shunt malfunctions are often invasive and expensive. To help solve this problem, NINDS-funded researchers are working to develop a safe, cost-effective method for diagnosing shunt malfunctions using ultrasound.
Not only do shunts malfunction, they also carry a high risk of infection. NINDS-funded scientists are attempting to identify and describe all the microorganisms present in CSF when shunts are placed, revised, and infected in order to improve prevention and treatment of CSF shunt infection.
More information about hydrocephalus research supported by the NINDS and other NIH Institutes and Centers can be found using NIH RePORTER (projectreporter.nih.gov), a searchable database of current and past research projects supported by NIH and other federal agencies. RePORTER also includes links to publications and resources from these projects.
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Where can I get more information?
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:
BRAIN
P.O. Box 5801
Bethesda, MD 20824
800-352-9424
Information also is avaliable from the following organizations:
Hydrocephalus Association
4340 East West Highway
Suite 905
Bethesda, MD 20814
Tel: 301-202-3811; 888-598-3789
Fax: 301-202-3813
National Hydrocephalus Foundation
12413 Centralia Road
Lakewood, CA 90715-1653
Tel: 562-924-6666; 888-857-3434
Pediatric Hydrocephalus Foundation
10 Main Street, Suite 335
Woodbridge, NJ 07095
Tel: 732-634-1283
"Hydrocephalus Fact Sheet", NINDS, Publication date April 2020.
NIH Publication No. 20-NS-385
Back to Hydrocephalus Information Page
See a list of all NINDS disorders
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Prepared by:
Office of Communications and Public Liaison
National Institute
of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.